Women with HIV are often viewed as potential mothers, so it is quite unusual for a survey to ask women with HIV of
childbearing age whether they actually want children. This is what the DIDI
study did in Italy.
This survey asked 178 women who were in a steady relationship
and under 45 years old, as part of a larger health survey that took place
between November 2010 and February 2011, whether they wanted a child, or
another child if they were already a mother.
Sixty-one per cent said ‘no’. This is not that surprising given
that the mean age of the group was 39, so more women were nearing menopause
than not, and 53% of them had a child already.
The women’s own health considerations were not an influence: this
was a group with an average CD4 count of 552 cells/mm3,
of whom 88% were on ART, with 79% of those (69% of all the women) with an
undetectable viral load.
However, answering ‘no’ was far more likely among the 44% of women
who had an HIV-negative partner. Thirty-one per cent of women were actively trying
for a child, but whereas 44% of women with HIV-positive partners said they wanted a
child, only 10% of women with HIV-negative partners did so.
Over half of the
women trying to conceive were simply doing so by having unprotected sex with their partner (including
half of the small number of women with HIV-negative partners) but about 20% used
self-insemination as a technique – even with HIV-positive partners – and another
20% (50% of those with negative partners) were seeking advice from a fertility
Half of the women said their HIV diagnosis had affected their
desire to have a child (or another child), and a third said it “very much” had.
Strikingly, women with an undetectable viral load were 69% more likely not to want a child, although this could
be because older women might be more likely to be on ART. Nearly a quarter
(22%) of the women said starting ART had reduced
their desire to have a child.
Women were asked: “If all necessary measures were adopted, how
likely do you think your child would be born without HIV?” Most women had a reasonably
accurate view of this: 35% said they thought that if everything was done, it was a certainty that their child
would be born without HIV and another 35% said there would be a less than 5%
chance. However 10% thought the chance was between 5% and 50% and 9.4% thought
the chance was over 50% (3.4% thought it was a certainty any child of theirs would be born with HIV).
When it came to predictors of wanting to have a child, Italian-born
women and former injecting drug users (who were also more likely to be native
Italians) were half as likely to want a child than other women, while women on
a low income (less than €800 a month) were four times more likely to want a child, though this reflects the fact that low-income
women were more likely to be young and/or African immigrants.
Low income was one of only two factors that had a statistically
significant association with wanting to have a child. The other was “fear of
vertical transmission”: women who said they were afraid that they would pass on
HIV to their child were 3.75 times more likely to not want to have a child, and
those who feared they would not live long enough to raise a child were 2.85
times more likely not to want one. Fear of having to disclose their own HIV
status to their child was another reason quoted by many women for not wanting a
Although this study serves as a useful reminder that women with HIV should not be regarded simply as potential child bearers,
it also suggests that among some women, exaggerated fears of infecting either
their partner or their child may be inhibiting them from becoming mothers.