ART Availability and Fertility Desire: Evidence from a Population-Based Cohort in Rakai, Uganda from 2001-2011

Sanyukta Mathur, Columbia University
Xiaobo Zhong, Columbia University
Tom Lutalo, Rakai Health Sciences Program
Kristin Wunder, Columbia University
Ying Wei, Columbia University
Maria Wawer, Johns Hopkins University
John Santelli, Columbia University

Generalized HIV epidemics, high fertility, and low contraceptive use, are an important context to examine fertility desire. We assessed if ART rollout had an impact on the fertility desires of HIV-positive and HIV-negative women enrolled in a population-based cohort in Uganda. We used data from women ages 15-49 years from 2001-2011, resulting a total of 42,195 person-round observations. Fertility desires included currently wanting a first child or wanting another child. We used bivariate and multivariate longitudinal generalized linear mixed models to assess the effects of HIV status and treatment phases (pre and post ART). Fertility desires increased after ART became available in 2004 (OR 1.60, 95% CI: 1.50 – 1.72), adjusting for socio-demographic and HIV-related factors. Fertility desires rose significantly among both HIV-positive (OR: 1.39 [95% CI: 1.18-1.63]) and HIV-negative (OR: 1.60 [95% CI: 1.50-1.70]) women. HIV treatment availability may increase fertility desire among women.