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Background: Fertility decision-making plays a negligible role in completing fertility goals among couples living with HIV (CLWH). Being commonly matched concerning fertility motivation seems essential for fertility desire/intention. Few studies report on intra-couple congruences or incongruences in fertility motivation on desire/intention. This study aims to assess the effects of (in)congruency in fertility motivation on fertility desire and intention among couples living with HIV. Methods: This study uses the actor-partner interdependence model (APIM) to assess the independent direct and indirect effect of fertility motivation on intention, and dyadic response surface analysis with congruency/incongruent effect (DRSA) of fertility motivation on intention using fertility desire as mediator variable among CLWH. CLWH were selected from a clinic in Kunming, China, between October and December 2020. Cross-sectional research included 314 CLWH. Results: APIM revealed that the wife's fertility motivation had an indirect influence on fertility intention of couples mediated by her fertility desire (R2 = 0.42). There was a significant effect on fertility intention by interaction of (in)congruency in fertility motivation among couples. DRSA shows that linear congruency in fertility motivation of both husband and wife increased fertility desire and intention of couples. However, if there was an incongruent in fertility motivation among husband and wife, husband's domination in fertility motivation was common and negatively affect the wife's fertility desire to have a child. Overall, couples who were matched on fertility motivation reported a significant greater relationship with fertility intention than couples who were mismatched. Conclusion: Counseling could help both the husband and wife achieve a greater positive fertility intention by addressing comparable fertility goals.
ABSTRACT
BACKGROUND: China's recent change from a one-child policy to a two-child policy has urged many couples/families to consider having a child or an additional child. However, little is known about such fertility desire among heterosexual couples with at least one human immunodeficiency virus (HIV)-positive partner. The objective of this qualitative study was to describe fertility desire and its motivating factors and barriers among people living with HIV (PLHIV). MATERIALS AND METHODS: We conducted in-depth semi-structured interviews in 31 patients at an antiretroviral therapy (ART) clinic in Kunming, China, from October to December 2020. We included only patients in a sexually active heterosexual relationship with no more than one child. Participants gave verbal informed consent before participation. Interview recordings were transcribed verbatim, translated into English, and then analyzed using thematic analysis. RESULTS: Participants who reported fertility desire were mostly male, while participants who reported no fertility desire were mostly female. Study participants reported motivating factors and barriers that were identical to HIV-negative persons such as 1) social norms, 2) Chinese sociocultural factors, 3) the government's two-child policy, and 4) the financial burden of having children. However, study participants also reported motivating factors and barriers unique to human immunodeficiency virus (HIV)-positive individuals that included 1) the availability of ART and prevention of mother-to-child HIV transmission services, 2) health-related concerns, 3) stigma and discrimination against PLHIV, and 4) the additional cost of child-rearing when HIV-positive. CONCLUSIONS: The study findings highlighted major areas of concern for relevant stakeholders. The development of PLHIV-specific health policy should consider the PLHIV-specific motivating factors and barriers reported in this study. However, social desirability and lack of generalizability should also be considered in the interpretation of this study's findings.
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OBJECTIVES: This study aimed to assess the influences of stigma and HIV status on reproductive intention among heterosexual couples living with HIV in China. METHODS: A cross-sectional study was conducted in Kunming, China among 315 HIV-positive individuals and their spouses (n = 315 couples). An interview questionnaire was used to collect data on intention, desire, HIV Stigma Scale items, and HIV status. Dyadic fertility intention was examined using the actor-partner interdependence mediation model, based on the Traits-Desires-Intentions-Behavior framework. RESULTS: The husbands' or wives' internalized stigma had significant negative effects on their own fertility desire (ß = -0.149, p<0.05 and ß = -0.238, p<0.01, respectively). HIV-positive status of the husbands was weakly linked to their own fertility intention (ß = -0.181, p<0.05). Husbands' perceived provider stigma was associated with their own and their wives' fertility intention via the mediating effect of their fertility desire (ß = -0.374, p<0.001 and ß = -0.203, p<0.01, respectively). The cumulative influence of their reproductive desire mediated the husband's perceived provider stigma and the wife's internalized stigma on their fertility intention. CONCLUSIONS: Stigma and HIV status were associated with fertility intention among couples living with HIV, mediated by fertility desire. The high intra-couple correlation suggested that counseling should be conducted when both spouses are present together with extensive discussions on concerns regarding HIV-related stigma, potential discrepancies between each partner's fertility desire and intention, and the influence of one partner on the other.
Subject(s)
HIV Infections , Heterosexuality , Humans , Intention , Cross-Sectional Studies , Fertility , ChinaABSTRACT
Introduction: HIV-related worries are a major barrier to achieving fertility goals for couples living with HIV (CLWH). We examined the moderating role of living children in the association between HIV-related worries and fertility motivation in CLWH including happiness, well-being, identity, and continuity. Methods: The data of 322 reproductive-aged CLWH were collected for this cross-sectional study from a referral antiretroviral therapy clinic in Kunming, China between October and December 2020. Intra- and interpersonal mechanisms of association between HIV-related worries and fertility motivation moderated by the number of living children in husband-wife dyads were analyzed by the actor-partner interdependence moderation model. Results: The high-level HIV-related worries of the wives and husbands were associated with the spouses' fertility motivation. Having at least one child helped to ameliorate the negative association between one's own HIV-related worries and fertility motivation. However, there was no evidence of such moderation in the spouse. Conclusion: Whether the CLWH has at least one living child should be taken into account in counseling. Childless families should be counseled on HIV-related worries as those worries have a greater negative effect on fertility motivation than couples who have a child.
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Background: Survival and quality of life of people living with HIV (PLWH) have been improving. Understanding fertility intention among PLWH is critical in helping them accomplish their pregnancy goals while significantly lowering the risk of HIV transmission. The purpose of this study was to identify factors based on the theory of planned behavior (TPB) that may explain fertility intention among PLWH. Methods: A survey was conducted in face-to-face interviews based on TPB, and the latent variables were devised and tested for their potential influences on fertility intentions in 487 reproductive-aged PLWH at antiretroviral treatment clinics in Kunming, China. Analysis was mainly based on the structural equation model. Results: About 38.4% of the respondents answered that they were likely to have a/another child in the next three years. Our hypothesized factors could explain 53.7% of the total variance of fertility intention. The 20- to 35-year-old group had a higher fertility intention. Perceived partner expectations toward fertility were the strongest predictors of fertility intention followed by beliefs in the support of the two-child policy. In contrast, the three components of attitudes, subjective norm, and perceived behavioral control did not influence fertility intention. Conclusion: In this HIV endemic area of China, fertility intended by PLWH is a matter of the couple that is also influenced by the national population fertility policy.
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BACKGROUND: The comorbid presence of tuberculosis and diabetes mellitus has become an increasingly important public health threat to the prevention and control of both diseases. Thus, household contact investigation may serve a dual purpose of screening for both tuberculosis and diabetes mellitus among household contacts. We therefore aimed to evaluate the coverage of screening for tuberculosis and diabetes mellitus among household contacts of tuberculosis index cases and to determine predictors of tuberculosis screening. METHODS: A household-based survey was conducted in February 2019 in Muang district of Phatthalung Province, Thailand where 95 index tuberculosis patients were newly diagnosed with pulmonary or pleural tuberculosis between October 2017 and September 2018. Household contacts of the index patients were interviewed using a structured questionnaire to ascertain their past-year history of tuberculosis screening and, if appropriate, diabetes mellitus screening. For children, the household head or an adult household member was interviewed as a proxy. Coverage of tuberculosis screening at the household level was regarded as households having all contacts screened for tuberculosis. Logistic regression and mixed-effects logistic regression models were used to determine predictors of tuberculosis screening at the household and individual levels, respectively, with the strengths of association presented as adjusted odds ratios (AOR) and 95% confidence intervals (CI). RESULTS: Of 61 responding households (64%), complete coverage of tuberculosis screening at the household level was 34.4% and among the 174 household contacts was 46.6%. About 20% of contacts did not receive any recommendation for tuberculosis screening. Households were more likely to have all members screened for tuberculosis if they were advised to be screened by a healthcare professional rather than someone else. At the individual level, contacts aged ≥35 years (AOR: 30.6, 95% CI: 2.0-466.0), being an employee (AOR: 0.1, 95% CI: 0.0-0.8) and those who had lived more than 5 years in the same household (AOR: 0.1, 95% CI: 0.0-0.8) were independent predictors for tuberculosis screening. Coverage of diabetes mellitus screening was 80.6% with lack of awareness being the main reason for not being screened. CONCLUSIONS: Compared to diabetes screening, the coverage of tuberculosis screening was low. A better strategy to improve coverage of tuberculosis contact screening is needed.
