Fertility desire is an intention to have children despite the diagnosis of HIV (1).Globally, HIV/AIDS is the leading cause of death among women of reproductive age (aged 15-49). In 2017, new infections among young women (aged 15-24 years) were 42% higher than they were among men in the same age group, and around 80% of pregnant women living with HIV received antiretroviral medicines to prevent the transmission of the virus to their children(2,3).
Women in Sub-saharan Africa between the ages of 15 and 24 years constitute 76% of those at risk for contracting HIV, and the risk of infection in this group is three times that of the general population(2).
Most of these women are particularly vulnerable to HIV due to the complex burdens they face, physiological and social vulnerability and gender inequalities. Since these vulnerable women are in the child bearing age, the risk of infecting their children and thus facing difficult choices about childbearing is huge (4).
Prior to the implementation of the Prevention to Mother to Child Transmission (PMTCT) programs, health care providers used to discourage women living with HIV from having children in order to avoid new infections in children though many women continued to bear children despite the knowledge about for the consequences. Even after antiretroviral treatment, there is evidence that healthcare providers have advised women living with HIV to avoid pregnancy. However, it is evidenced in a number of studies that many HIV positive women have children and to have wish more, indicating the need for comprehensive care, so such women can have safe and healthy pregnancy(5)
The major mode of HIV transmission in Ethiopia is heterosexual, decisions about child bearing among women living with HIV/AIDS (WLHA) continue to be a subject of debate in resource constrained settings. Many findings show that HIV/AIDS is integrated-in the minds of many developing countries as they confront the very real and present danger posed by heterosexual transmission of the virus. Yet, many women who participate in studies spontaneously mention the influence of HIV/AIDS in reducing their family size as well as their compatriots (6).
Research findings reported that social norms and individual factors often discouraged HIV infected people from having children and childbearing decisions. As the prevention of the mother to child transmission programs provide for both prevention of HIV transmission from mother to child and enrollment of infected pregnant women and their families into antiretroviral treatment, the government of Ethiopia made an effort to mitigate the impacts of the epidemic in the general population and amongst children in particular(7).
A better understanding of the reproductive choices of HIV positive individuals is important, especially as antiretroviral medication is becoming more accessible. Accurate descriptions of the childbearing intentions and desires of HIV infected individuals is necessary because it may help them achieve their fertility desires without scarifying the health and wellbeing of their new born (8).
Studies report inconsistencies in the prevalence of fertility desires. For instance, among infected people in Canada (10), Switzerland(12), Congo(13), Spain(14) ,Malawi (15) and Uganda (16) the magnitude varied as 58,48,35.5,49,34 and 35%, respectively . Likewise, Studies conducted in Ethiopia desires ranged from 28.8 to 70.59 %( 5, 17-20).
In case women living with HIV desire to have children, counselling by their health care providers has a critical role in assuring the planned pregnancies, and improving the prevention of mother to child transmission and reducing new infant infections (9).
Although Ethiopia has made efforts to mitigate the impacts of the epidemic in the general population (9), many women are living with HIV/AIDS. In spite of advances in ART and prevention of mother-to-child transmission services, women in developing settings still struggle with decisions to have children. More importantly, little is known about the prevalence and determinants of fertility intentions among HIV infected women who are receiving ART. Therefore, this study was conducted to assess fertility desires and associated factors among HIV positive women at the University of Gondar comprehensive specialized hospital.