Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-19T20:29:09.280Z Has data issue: false hasContentIssue false
  • English
  • Français

FERTILITY AMONG HIV-INFECTED INDIAN WOMEN: THE BIOLOGICAL EFFECT AND ITS IMPLICATIONS

Published online by Cambridge University Press:  12 October 2010

SHRINIVAS DARAK ,
FANNY JANSSEN  and
INGE HUTTER
SHRINIVAS DARAK
Affiliation:
Population Research Centre, University of Groningen, The Netherlands
FANNY JANSSEN
Affiliation:
Population Research Centre, University of Groningen, The Netherlands
INGE HUTTER
Affiliation:
Population Research Centre, University of Groningen, The Netherlands
Get access Rights & Permissions [Opens in a new window]

Summary

In India, nearly one million women of childbearing age are infected with HIV. This study sought to examine the biological effect of HIV on the fertility of HIV-infected Indian women. This is relevant for the provision of pregnancy-related counselling and care to the infected women, and for estimating the HIV prevalence among women and children. The study used retrospectively collected data from the National Family Health Survey (2005–2006) and applied a matched case control study design to compare the effect of HIV on conception, pregnancy rates and pregnancy outcomes among HIV-infected (N=69) and HIV-non-infected (N=345) women, both unaware of their HIV status. Pregnancy rates and pregnancy outcomes were compared through non-parametric statistical tests, whereas the effect of HIV on fecundity was studied by analysing the interval between last two pregnancies using Cox regression. The pregnancy rate was observed to be lower among HIV-infected than HIV-non-infected women (RR=0.77). The difference, however, was not statistically significant (p=0.064). There was also no statistically significant difference in the interval between last two pregnancies (p=0.898). Significantly higher number of pregnancies among HIV-infected women resulted in termination because of miscarriage or stillbirths (p=0.004). Therefore, while providing clinical care and counselling to infected women, the possibility of adverse pregnancy outcomes should be considered. Due to the higher rate of adverse pregnancy outcomes, attendance of HIV-infected women at antenatal clinics might be greater, which could lead to overestimation of HIV prevalence derived from antenatal care surveillance sites.

Type
Research Article
Information
Journal of Biosocial Science , Volume 43 , Issue 1 , January 2011 , pp. 19 - 29
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bongaarts, J. & Potter, R. G. (1983) Fertility, Biology and Behavior: An Analysis of Proximate Determinants. Academic Press, New York.Google Scholar
Brocklehurst, P. & French, R. (1998) The association between maternal HIV infection and perinatal outcome: a systematic review of the literature and meta-analysis. British Journal of Obstetrics and Gynaecology 105, 836–848.CrossRefGoogle ScholarPubMed
Carla, D. U., Pezzotti, P., Rezza, G., Branca, M., Ippolito, G. & The Dianaids Collaborative Study Group (1998) Association between HIV-1 infection and miscarriage: a retrospective study. AIDS 12, 1087–1093.Google Scholar
Carpenter, L. M., Nakiyingi, J. S., Ruberantwari, A., Malamba, S. S., Kamali, A. & Whitworth, J. A. G. (1997) Estimates of the impact of HIV infection on fertility in a rural Ugandan population cohort. Health Transition Review 7 (Supplement 2), 113–126.Google Scholar
Chu, S. Y., Hanson, D. L., Jones, J. L. & The Adult/Adolescent HIV Spectrum of Disease Project Group (1996) Pregnancy rates among women infected with human immunodeficiency virus. Obstetrics & Gynecology 87, 195–198.CrossRefGoogle ScholarPubMed
Dandona, L. & Dandona, R. (2007) Drop of HIV estimate for India to less than half. Lancet 370(9602), 1811–1813.CrossRefGoogle ScholarPubMed
Desgrees Du Lou, A., Msellati, P., Yao, A., Noba, V., Viho, I., Roman, R., Welffens-Ekra, C. & Dabis, F. (1999) Impaired fertility in HIV-1-infected pregnant women: a clinic-based survey in Abidjan, Côte d'Ivoire, 1997. AIDS 13, 517–521.Google Scholar
Forsyth, A. D., Coates, T. J., Grinstead, O. A., Sangiwa, G., Balmer, D., Kamenga, M. C. & Gregorich, S. E. (2002) HIV infection and pregnancy status among adults attending voluntary counseling and testing in 2 developing countries. American Journal of Public Health 92(11), 1795–1800.Google Scholar
Gangakhedkar, R. R., Bentley, M. E., Divekar, A. D., Gadkari, D., Mehendale, S. M., Shepherd, M. E., Bollinger, R. C. & Quinn, T. C. (1997) Spread of HIV infection in married monogamous women in India. Journal of the American Medical Association 278(23), 2090–2092.CrossRefGoogle ScholarPubMed
George, R., Thomas, K., Thyagarajan, S. P., Jeyaseelan, L., Peedicayil, A., Jeyaseelan, V., George, S. & The STD Study Group (2004) Genital syndromes and syndromic management of vaginal discharge in a community setting. International Journal of STD and AIDS 15, 367–370.CrossRefGoogle Scholar
Glynn, J. R., Buve, A., Carael, M., Kahindo, M., Macauley, I. B., Musonda, R. M., Jungmann, E., Tembo, F. & Zekeng, L. (2000) Decreased fertility among HIV-1 infected women attending antenatal clinics in three African cities. Journal of Acquired Immune Deficiency Syndromes 25, 345–352.CrossRefGoogle ScholarPubMed
Gordis, L. (2004) Epidemiology, Third Edition. Elsevier Saunders, Philadelphia.Google Scholar
Gray, R. H., Wawer, M. J., Serwadda, D., Sewankambo, N., Li, C., Wabwire-Mangen, F. et al. (1998) Population-based study of fertility in women with HIV-1 infection in Uganda. Lancet 351, 98–103.Google Scholar
Gregson, S., Zaba, B. & Hunter, S. C. (1998) The Impact of HIV-1 on Fertility in Sub-Saharan Africa: Causes and Consequences. URL: http://www.un.org/esa/population/publications/completingfertility/RevisedZabapaper.PDFGoogle Scholar
Hunter, S. C., Isingo, R., Boerma, J. T., Urassa, M., Mwaluko, G. M. P. & Zaba, B. (2003) The association between HIV and fertility in a cohort study in rural Tanzania. Journal of Biosocial Science 35, 189–199.CrossRefGoogle Scholar
IIPS & Macro International (2007) National Family Health Survey (NFHS-3) 2005–2006. Mumbai, India.Google Scholar
Kongnyuy, E. J. & Wiysonge, C. S. (2008) Association between fertility and HIV status: what implications for HIV estimates? BMC Public Health 8, 309.CrossRefGoogle ScholarPubMed
Massad, L. S., Springer, G., Jacobson, L., Watts, H., Anastos, K., Korn, A. et al. (2004) Pregnancy rates and predictors of conception, miscarriage and abortions in US women with HIV. AIDS 18, 281–286.Google Scholar
NACO (2007a) Annual HIV Sentinel Surveillance Country Report. New Delhi.Google Scholar
NACO (2007b) Operational Guidelines for Integrated Counselling and Testing Centres. New Delhi.Google Scholar
NACO (2008a) HIV Sentinel Surveillance and HIV Estimation in India 2007: A Technical Brief. New Delhi.Google Scholar
NACO (2008b) HIV Sentinel Surveillance and HIV Estimation, 2006. New Delhi.Google Scholar
Newmann, S., Sarin, P., Kumarasamy, N., Amalraj, E., Rogers, M., Madhivanan, P. et al. (2000) Marriage, monogamy and HIV: a profile of HIV-infected women in south India. International Journal of STD and AIDS 11, 250–253.CrossRefGoogle ScholarPubMed
Pandey, A., Reddy, D. C., Ghys, P. D., Thomas, M., Sahu, D., Bhattacharya, M. et al. (2009) Improved estimates of India's HIV burden in 2006. Indian Journal of Medical Research 129(1), 50–58.Google ScholarPubMed
Ross, A., Morgan, D., Lubega, R., Carpenter, L. M. & Mayanja, B. (1999) Reduced fertility associated with HIV: the contribution of pre-existing subfertility. AIDS 13, 2133–2141.CrossRefGoogle Scholar
Ross, A., Van Der Paal, L., Lubega, R., Mayanja, B., Shafer, L. A. & Whitworth, J. (2004) HIV-1 disease progression and fertility: the incidence of recognized pregnancy and pregnancy outcome in Uganda. AIDS 18, 799–804.CrossRefGoogle ScholarPubMed
Sedgh, G., Larsen, U., Spiegelman, D., Msamanga, G. & Fawzi, W. W. (2006) HIV-1 infection and fertility in Dar es Salaam, Tanzania. African Journal of Reproductive Health 10(3), 41–52.CrossRefGoogle ScholarPubMed
Spira, A. (1998) The use of fecundability in epidemiological surveys. Human Reproduction 13(7), 1753–1756.CrossRefGoogle ScholarPubMed
Van Benthem, B. H. B., De Vincenzi, I., Delmas, M-C., Larsen, C., Van Den Hoek, A., Prins, M. & The European Study on the Natural History of HIV Infection in Women (2000) Pregnancies before and after HIV diagnosis in a European cohort of HIV-infected women. AIDS 14, 2171–2178.CrossRefGoogle Scholar
Van Eijk, A. M., De Cock, K. M., Ayisi, J. C., Rosen, D. H., Otieno, J. A., Nahlen, B. L. & Steketee, R. W. (2004) Pregnancy interval and delivery outcome among HIV-seropositive and HIV-seronegative women in Kisumu, Kenya. Tropical Medicine & International Health 9(1), 15–24.Google Scholar
WHO (2001) Global Prevalence and Incidence of Selected Curable Sexually Transmitted Infections: Overview and Estimates. WHO, Geneva.Google Scholar
WHO (2007) Global Strategy for the Prevention and Control of Sexually Transmitted Infections: 2006–2015: Breaking the Chain of Transmission. WHO, Geneva.Google Scholar
WHO (2008) Technical Consultation to Review HIV Surveillance in India. WHO, Geneva.Google Scholar
Zaba, B. & Gregson, S. (1998) Measuring the impact of HIV on fertility in Africa. AIDS 12 (Supplement 1), S41–50.Google ScholarPubMed