Fertility among women living with HIV in western Ethiopia and its implications for prevention of vertical transmission: a cross-sectional study

OBJECTIVE: This study aimed to examine fertility (live births) in the last 3 years and its associated factors among women living with HIV (WLHIV) in western Ethiopia. DESIGN: Participants were recruited into a cross-sectional survey using systematic sampling. SETTINGS: Four healthcare facilities in western Ethiopia were included. PARTICIPANTS: Eligible participants were WLHIV of reproductive age (15–49 years) from western Ethiopia who found out about their HIV-positive status more than 3 years ago (N=866). PRIMARY OUTCOME MEASURES: The fertility (live births) of HIV-positive women in the last 3 years was surveyed using face-to-face interviews (March–June 2018). Logistic regression analyses were conducted to examine factors influencing fertility in the last 3 years. RESULTS: A total of 108 (12.5%) HIV-positive women gave birth to 121 live children in the last 3 years. Of these births, 18.2% were reported as mistimed at conception, while 26.4% were reported as unwanted. Of the live births, 8.3% ended in death. Of the 76 (62.8%) children with known HIV status born to HIV-positive women in the last 3 years, 7.9% were HIV-positive. In terms of predictors of fertility, women aged 15–24 years (adjusted OR (AOR) 2.72; 95% CI 1.14 to 6.49) and 25–34 years (AOR 4.34; 95% CI 2.61 to 7.21) had increased odds of fertility compared with women aged 35–49 years. Women using antiretroviral therapy (ART) for less than 5 years were more likely to have given birth in the last 3 years compared with those using ART for 10 years or more (AOR 2.96; 95% CI 1.19 to 7.36), even after controlling for age. CONCLUSIONS: WLHIV in Ethiopia are having children and so it is imperative that safe conception strategies are readily available as well as support to reduce HIV-related risks for children born to these mothers. Strengthening reproductive health services for HIV-positive women in order to achieve their family planning goals is therefore important.