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Effect of Anteritroviral Therapy(ART) on Fertility Intention and contraceptive prefernce of HIV positive women in Addis Ababa, Ethiopia

Background: The advent of antiretroviral therapy (ART) has improved quality of life and 
survival for people living with HIV (PLWH) and now days HIV infection can be seen as a 
chronic manageable disease, as a result many will contemplate child bearing. Although, ART 
has influence in improving quality of life and reduce mother to child transmission of HIV virus 
(MTCT) in developed countries, vertical transmission accounts for more than 90% of pediatric 
AIDS in prevalent areas, as a result, reproductive assistance to HIV positive women is 
important to have informed decision making about child bearing and child rearing. 
In Ethiopia, while anti-retroviral therapy (ART) services are increasingly available, information 
about fertility intentions, contraceptive use and method preference among women living with 
HIV in relation to ART use is scarce. Moreover, change in fertility intentions 12 months after 
ART intiation and reasons in selection of those options are lacking. Those factors raise concern 
on possible exposure of many HIV positive women to the potential risk of unintended pregnancy 
and hinder them from seeking options. 
Objectives: the purpose of the study was to assess effect of ART on the fertility intentions and 
contraceptive use and method preference of HIV positive women in Addis Ababa, Ethiopia. 
Methodology: Health facility based cross sectional quantitative and qualitative studies including 
follow up studies were conducted. For the quantitative part, a total of 1855 HIV positive women 
aged 15-49 years for cross sectional survey and 360 HIV positive women participated for the 
follow up study. Focus group discussion, in depth interviews and key informant interviews were 
done for the qualitative part. Data were collected from June 2012 to December 2013 using 
validated structured questionnaires for quantitative and semi structured questionnaires for 
qualitative part. Data were double entered in to epidemiological software (Epi Info version 
3.5.1). Descriptive statistics, bivareate and multivariate statistical analysis were done using SPSS 
version 20 soft ware.Results: Overall, 44% of women reported childbearing intention and 71% women reported 
using contraception 75% (n=579) ART users and 65% (n=422) ART naive women. Male 
condom and injectables were the most preferred contraceptive methods among both groups. The 
proportion of fertility intention 12 months after antiretroviral therapy (ART) initiation was higher 
among ART initiated 55.5% (n=106) than ART naive 40% (n=68) women. The presence of 
ART, improvement of health condition and the influence of husband, family, community and 
associated stigma were the main reasons for childbearing intentions of women in the study area. 
In adjusted logistic regression analysis, ART users had higher fertility intention (AOR; 1.26, 
95%CI; 1.01 to 1.60) than ART naive. Furthermore, being in a sexual relationship, young age, 
being single and having fewer or no children were found to be predictors of fertility intentions. 
Women receiving ART reported more use of contraceptives (AOR 1.60, 95% CI, 1.30- 2.12) 
than ART naive women. In addition to this, presence of partner (AOR 2.32, 95% CI, 1.60-3.40), 
disclosure of HIV status to husband (AOR 2.23, 95 % CI, 1.21-4.12), presence of living 
children: one (AOR 1.7, 95% C I, 1.03-2.40), two (AOR 2.6, 95% CI, 1.7-4.02) and three (AOR 
3.3, 95% CI, 1.90-5.60) respectively were found to be predictors of contraceptive use among 
HIV positive women. 
Overall, 41.0 % (147/360) of the women reported fertility intentions at the baseline, while 48.3 
%( 174/360) reported fertility intentions 12 months after follow up. The proportion of fertility 
intention 12 months after antiretroviral therapy (ART) initiation was higher among ART initiated 
55.8% (106/190) than HAART naive 40% (68/170) women. Furthermore, the need for more 
children 12 months after ART initiation was significantly associated with woman’s ART use 
(AOR, 2.46, 95%CI, 1.20-5.20). Single and married women (AOR, 5.32, 95%CI, 1.10-25.92) 
(AOR: 6.34, 95%CI, 1.43-27.99) respectively, were more likely to report fertility intention than 
divorced/ widowed women. Women who had at least one child (AOR, 0.32, 95% CI, 0.13-0.85) 
were less likely to change fertility intentions compared to women with no children. 
Conclusions: Fertility intentions are common among HIV positive women and change in 
intention for a child starts soon after initiation of ART. About three in four HIV positive women 
use contraceptive methods mainly condoms. Dual contraceptive method use was negligible 
among the study subjects.Fertility and contraceptive decisions of women are influenced by presence of ART, partner 
desire, family and community perception and associated stigma. Many participants indicated 
that health service providers are supportive in offering information more on preventive methods 
rather than discussing fertility and contraceptive options. 
Recommendations: It is necessary to strengthen an integrated sexual and reproductive health 
(SRH) service and HIV prevention, ART services to address the diverse SRH needs of HIV 
positive women in the study area. Furthermore, updating health care providers with fertility and 
contraceptive knowledge is valuable to enhance family planning and preventive practice of 
women.fertility intention, contraceptive use, method preference, HIV, ART, women, Addis 
Ababa, Ethiopia