Fertility desires and intentions of HIV-positive men and women

Context: HIV-positive men and women may have fertility desires and may inte nd to have children. The extent of these desires and intentions and how the y may vary by individuals' social and demographic characteristics and healt h factors is not well understood. Methods: Interviews were conducted from September through December 1998 wit h 1,421 HIV-infected adults who were part of the HIV Cost and Services Util ization Study, a nationally representative probability sample of 2,864 HIV- infected adults who were receiving medical care within the contiguous Unite d States in early 1996. Results: Overall, 28-29% of HIV-Infected men and women receiving medical ca re in the United States desire children in the future. Among those desiring children, 69% of women and 59% of men actually expect to have one or more children in the future. The proportion of HIV-infected women desiring a chi ld in the future is somewhat tower than the overall proportion of U.S. wome n who desire a child. The fertility desires of HIV-infected individuals do not always agree with those of their partners: As many as 20% of HIV-positi ve men who desire children have a partner who does not. Generally, HIV-posi tive individuals who desire children are younger have fewer children and re port higher ratings of their physical functioning or overall health than th eir counterparts who do not desire children, yet desire for future childbea ring is not related to measures of HIV progression. HIV-positive individual s who expect children are generally younger and less likely to be married t han those who do not. Multivariate analyses indicate that black HIV-positiv e individuals are more likely to expect children in the future than are oth ers. While HIV-positive women who already have children are significantly l ess likely than others both to desire and to expect more births, partner's HIV status has mixed effects: Women whose partner's HIV status is known are significantly less likely to desire children but are significantly more li kely to expect children in the future than are women whose partners HIV sta tus is unknown. Moreover, personal health status significantly affects wome n's desire for children in the future but not men's, while health status mo re strongly influences men's expectations to have children. Conclusions: The fact that many HIV-infected adults desire and expect to ha ve children has important implications for the prevention of vertical and h eterosexual transmission of HIV the need for counseling to facilitate infor med decision-making about childbearing and childrearing, and the future dem and for social services for children born to infected parents.