Journal of Biosocial Science

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Regular Articles

THE ASSOCIATION BETWEEN HIV AND FERTILITY IN A COHORT STUDY IN RURAL TANZANIA


SUSAN-CATHERINE  HUNTER  a1, RAPHAEL  ISINGO  a2, J. TIES  BOERMA  a3, MARK  URASSA  a2, GABRIEL M. P.  MWALUKO  a2 and BASIA  ZABA  a1
a1 Centre for Population Studies, London School of Hygiene and Tropical Medicine, London
a2 Tanzania-Netherlands Project to Support HIV/AIDS Control, Mwanza, Tanzania
a3 Carolina Population Center, School of Public Health, University of Northern Carolina at Chapel Hill, North Carolina, USA

Abstract

Recent studies in sub-Saharan Africa have shown that fertility is reduced among HIV-infected women compared with uninfected women. The size and pattern of this fertility reduction has important implications for antenatal clinic-based surveillance of the epidemic and also for estimates and projections of the demographic impact of the epidemic. This paper examines the association between HIV and fertility in Kisesa, a rural area in Tanzania, where HIV prevalence among adults is about 6% and gradually increasing. The analysis is based on data obtained through a demographic surveillance system in Kisesa during 1994–98 and two large sero-surveys of all residents in 1994–95 and 1996–97. The HIV-associated fertility reduction among women was investigated by estimating fertility rates by HIV status and prevalence rates by fertility status. A substantial reduction (29%) was observed in fertility among HIV-infected women compared with HIV-uninfected women. The fertility reduction was most pronounced during the terminal stages of infection, but no clear association with duration of infection was observed. Use of modern contraception was higher among HIV-infected women. However, both among contracepting and noncontracepting women, a substantial reduction in fertility was seen among HIV-infected women.