Socio-cultural and systematic factors influencing fertility desire among women living with HIV: a systematic literature review

Women and girls in Sub-Saharan Africa remain disproportionately affected by HIV. HIV care strategies can significantly reduce the risk of mother-to-child transmission of HIV. Women living with HIV (WLHIV) often experience barriers to reproductive decision-making. The purpose of this study was to identify factors influencing reproductive decision-making among WLHIV in Sub-Saharan Africa. A systematic literature review was conducted following PRISMA guidelines. The PEN-3 model was used to categorize identified factors into Positive, Existential and Negative Perceptions, Enablers and Nurturers. Eighteen articles were reviewed. Individual-level factors associated with a greater desire for children included being under 40 years old, married or cohabitating and having fewer than three children. Socio-cultural factors associated with a greater desire for children included the belief that having children strengthens relationships; reliance on other WLHIV for navigating pregnancy and positive community attitudes toward WLHIV. Modifiable socio-cultural barriers included: perceived HIV stigma; stigmatizing attitudes of healthcare providers and pressure from community members and male partners to have children. Culturally responsive reproductive health services that address systemic and socio-cultural barriers are needed. Interventions should focus on reducing healthcare provider stigma, increasing access to safer conception methods and modifying socio-cultural norms that impede reproductive decision-making among WLHIV.