# Proportion and factors associated with fertility desires among human immunodeficiency virus-positive adults receiving antiretroviral therapy in Northeast Ethiopia

## TL;DR

This study explores how many HIV-positive adults in Ethiopia want children and what factors influence this desire, finding that nearly half express a wish to have children.

## Contribution

The study provides new insights into fertility desires among HIV-positive adults in Northeast Ethiopia, identifying key demographic and reproductive factors.

## Key findings

- Approximately 52.1% of HIV-positive adults receiving ART expressed a desire to have children.
- Younger age groups (18–29 and 30–40) and those with fewer children showed significantly higher odds of fertility desire.
- Widowed individuals and those unaware of mother-to-child transmission had lower odds of desiring children.

## Abstract

The desire to have children can become a significant consideration for many people living with HIV (PLHIV), both men and women, particularly as access to antiretroviral therapy (ART) increases and rates of mother-to-child transmission (MTCT) decline. With the life-prolonging benefits and positive clinical outcomes associated with ART, HIV-positive adults may experience an increased desire to parenting. Nevertheless, research on fertility desires among this demographic remains sparse, especially in Northeast Ethiopia. This study aims to assess the proportion of fertility desires and identify the associated factors among HIV-positive adults receiving care in ART units in Northeast Ethiopia.

A cross-sectional study was conducted from 15 May to 15 June 2022, among 406 individuals living with HIV who were receiving ART in healthcare facilities located in the Meket District of Northeast Ethiopia. The study population consisted of reproductive-age men (18–60 years) and women (15–49 years) who had at least one visit to the ART care units during the study period. Participants were selected through systematic random sampling. Data were collected using self-administered questionnaires. Data entry and analysis were performed using EpiData version 3.1 and Stata version 14.0, respectively. Multivariable logistic regression was employed to identify factors significantly associated with fertility desire, with a p-value of <0.05 indicating statistical significance.

The study found that 52.1% of participants expressed a desire for children (95% CI: 47.9, 57.6). Several key factors were associated with fertility desire; specifically, widowed individuals had lower odds of desiring children, while those aged 18–29 had higher odds (AOR: 2.3, 95% CI: 1.1–4.8) compared with those aged 41 and older. Participants aged 30–40 also showed increased odds (AOR: 2.1, 95% CI: 1.3–3.3). Additionally, individuals with one or fewer children had significantly higher odds of fertility desire (AOR: 2.4, 95% CI: 1.2–4.6), and those with 2–3 children had an AOR of 1.9 (95% CI: 1–3.5). A lack of awareness regarding MTCT was linked to an AOR of 2.1 (95% CI: 1–4.4) for expressing a desire for children.

The findings demonstrate a relatively high proportion of fertility desire among HIV-positive adult men and women on ART in Northeast Ethiopia from the national prevalence. This finding underscores efforts that should be directed at individuals aged 18–29 years, who show significantly higher odds of wanting children, along with those aged 30–40 years, those with one or fewer children, and those with two to three children to enhance fertility desire. It is also important to address the needs of widowed individuals, who have lower odds of desiring children, by providing tailored supportive services. The study underscores the necessity for awareness-raising initiatives concerning the prevention of mother-to-child transmission among PLHIV by healthcare providers, highlighting the importance of informed reproductive health choices for PLHIV.