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The Impact of HIV Status and Perceived Status on Fertility Desires in Rural Malawi

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Abstract

Surprisingly little is known about how or if knowledge of one’s HIV status influences the desire to have children in sub-Saharan Africa. This paper takes advantage of a unique situation in rural Malawi where no one knew their HIV status prior to testing being introduced as part of an ongoing panel study. Using a sample of men and women (n = 1,380) who were interviewed in 2001 and 2006, we examine how HIV positive and negative test results impact respondents’ desires to continue childbearing. We then consider how prior perceptions of one’s status influence this effect. Respondents who received a positive test result reduced their childbearing desires. When self-assessed likelihood of infection was considered, however, only those who were surprised by their test result altered their fertility preferences, a finding which held true for both positive and negative results. The implications of the results and potential applications to other HIV/AIDS research are discussed.

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Notes

  1. Malawi Diffusion and Ideational Change Project (PIs Susan Watkins, Hans-Peter Kohler and Jere Behrman). Detailed descriptions of the MDICP sample selection, data collection and data quality are provided in a 2003 Special Collection of the online journal Demographic Research that is devoted to the MDICP and on the project website: http://www.malawi.pop.upenn.edu/.

  2. This group includes those who said they “do not know”. This is a difficult group to categorize. While their actual HIV prevalence was similar to those who thought they had a high likelihood of infection, what is relevant here is what they thought of their risk. The analyses were run with this group in both categories, as well as dropped entirely. The results did not change substantially; the method chosen was considered to be a conservative approach.

  3. HIV prevalence for the entire 2004 MDICP sample was 6.7%–5.7% of men and 7.6% of women (though they did not all receive their test result). The longitudinal sample has lower HIV prevalence because of disproportionate attrition among HIV positive individuals—HIV positive individuals in 2004 were more likely to have died and more likely to not be found in 2006. The potential bias introduced is not believed to substantially affect the results because there is no clear theoretical reason why mortality would be higher among infected persons who were more or less likely to change their fertility preferences. In fact, the findings are most relevant to those with lower mortality—the least ill—whose fertility preferences are of greater demographic and epidemiologic relevance.

  4. Tested using subgroup analysis (Altman and Bland 2003)

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Acknowledgments

Data collection and the author’s time were supported by funding from NIH (5 T32HD007081, R01 HD/MH41713, R01 HD373-276, R01 HD044228) and NSF (SES-0623543). This paper is a version of a paper presented at the Union for African Population Studies 5th Annual Meeting in Arusha, Tanzania, December 2007. Susan Watkins and Joe Potter provided helpful comments on an earlier draft.

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  1. Department of Health and Behavioral Sciences, University of Colorado Denver, Campus Box 188, P.O. Box 173364, Denver, CO, 80217, USA

    Sara E. Yeatman

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Yeatman, S.E. The Impact of HIV Status and Perceived Status on Fertility Desires in Rural Malawi. AIDS Behav 13 (Suppl 1), 12–19 (2009). https://doi.org/10.1007/s10461-009-9534-1

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