The relationship between HIV and fertility in a context of expanding ART access

Date: 1/1/2013 - 12/31/2018
Principal Researchers: Yeatman, S. Location: Malawi

Sara Yeatman, PhD, Assistant Professor of Department of Health and Behavioral Sciences, University of Colorado Denver; Faculty Associate Institute of Behavioral Science, University of Colorado Boulder is conducting this project from 2013-2018; it is an extension of an earlier project in the same community. Access to antiretroviral therapy (ART) and policies around HIV treatment are expanding throughout sub-Saharan Africa (SSA). Recent improvements in the treatment context in Malawi stand to alter the bi-directional relationship between HIV and fertility. Of particular relevance is “Option B+”, a new program designed to provide universal and lifelong access to ART to pregnant, HIV+ women. Because such a policy has never been implemented before, Option B+ offers an important opportunity to learn about the implications of widespread ART access for reproductive goals and behaviors and the knock-on effects for HIV transmission. The current project builds upon longitudinal data collected by Tsogolo la Thanzi (TLT-1) between 2009-11 from approximately 3000 young adults living in Balaka, Malawi. TLT-2 (2015) will focus on respondents’ reproductive, relationship, sexual, contraceptive, and biomedical service use histories. The original cohort will have aged to 21-31—years of peak childbearing and acute risk for HIV infection. In particular, we will examine the expected and unanticipated consequences of this new policy on fertility patterns and the implications for vertical and horizontal HIV transmission. These individual- and couple-level data will be combined with detailed data collected from clinics and policymakers examining the realities of policy implementation at the local level. This combined couple-based and institutionally informed approach to understanding the changing relationship between HIV and fertility—a crucial dimension of reproductive health in SSA—stands to inform both research and policy by providing a preliminary evidentiary basis for how other “test and treat” policies in high-prevalence settings might influence fertility behavior and HIV transmission.
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