Fertility Desires and Intentions and the Relationship to Consistent Condom Use and Provider Communication Regarding Childbearing Among HIV Clients in Uganda

Family planning services emphasize prevention of unplanned pregnancies, but rarely account for the childbearing desires of HIV clients. We examined the correlates of fertility desires and intentions among 767 HIV clients (34% male) starting antiretrovirals in Uganda. Half of participants had a primary sex partner. Among those with a desire (31%) or intention (24%) for having a child in the near future, 60% had not discussed this with providers. Over one quarter (27%) were told by their provider that they should not bear a child because of their HIV status. In regression analysis, male gender, younger age, higher CD4, having fewer children, and having a primary partner were associated with fertility desires and intentions; having been told by provider not to have a child was associated with intentions but not desires. Among participants with a primary partner, consistent condom use was greater among those with no fertility intentions, as was receipt of advise about family planning, while HIV disclosure to partner was greater among those with intentions. Partner HIV status was not associated with fertility desires or intentions. These findings highlight the need for reproductive health programs for HIV clients to incorporate safer conception counseling and improve communication regarding childbearing.