Socio-Cultural and Systematic Factors Impacting Fertility Desire among Women Living with HIV: A Systematic Literature Review

Juliet Bonnah, PA, Janell Addo-Boateng, Dr. Rochelle Davidson Mhonde, & Dr. Michelle S. Williams

Abstract

Introduction: Women and girls in Sub-Saharan Africa remain disproportionately affected by HIV. Advanced HIV care strategies can significantly reduce the risk of mother-to-child transmission of HIV. Women living with HIV (WLHIV) often experience barriers to reproductive decision-making. The purpose of this study was to identify factors influencing reproductive decision-making among WLHIV in Sub-Saharan Africa to inform interventions that improve maternal and child health outcomes.

Methods: A systematic literature review was conducted following PRISMA guidelines, extracting articles from three scientific databases. The PEN-3 model was used to categorize identified factors into positive, existential, and negative perceptions, enablers, and nurturers.

Results: Eighteen articles were included in the review. Individual-level factors associated with a greater desire for children among WLHIV included being under 40 years old, married or cohabitating, in good health (as indicated by CD4 cell count), having fewer than three children, higher education levels, and financial security. Socio-cultural factors that were associated with a greater desire for children included: Positive Perceptions, such as knowledge of safer conception strategies and the belief that having children strengthens relationships; Positive Enablers included community support and reliance on other WLHIV for navigating pregnancy; and Positive Nurturers included male partners' who had a desire for children and positive community attitudes toward WLHIV. Modifiable socio-cultural barriers to fertility among WLHIV included: Negative Perceptions such as the lack of knowledge about safer conception methods and perceived HIV stigma; Negative Enablers such as stigmatizing attitudes of healthcare providers; and Negative Nurturers for example community pressure to have children and male partners' insistence on having children.

Conclusion: There is a need for culturally responsive reproductive health services that address systemic and socio-cultural barriers. Interventions should focus on reducing healthcare provider stigma, increasing access to safer conception methods, and modifying socio-cultural norms that impede reproductive decision-making among WLHIV.

References

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