Mediation of the association between stigma and HIV status and fertility intention by fertility desire among heterosexual couples living with HIV in Kunming, China

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 (β = −0.149, p<0.05 and β = −0.238, p<0.01, respectively). HIV-positive status of the husbands was weakly linked to their own fertility intention (β = −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 (β = −0.374, p<0.001 and β = −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.