Concern has been expressed about the fertility of people infected with HIV: the worry has been that on learning of their condition, HIV-affected individuals may attempt to accomplish unmet reproductive goals knowing that they will not live a normal life span. This article addresses the potential effects of AIDS on fertility and reproductive decisions in East and Central Africa. The problem is seen in terms of a tightly knit continuum of biological, epidemiologic and cultural contexts, and the prevailing conditions of response to the epidemic. AIDS can influence fertility among individuals and groups regardless of any awareness of serostatus by increasing death rates among reproductive populations, and damaging the physical capacities of infected men and women to reproduce. In much of the region, high prevalence of STDs may simultaneously impair the fertility of men and women and increase their risk of contracting HIV. These biological conditions are compounded among those for whom fertility is a highly valued marker of adult status, where the social and economic marginality of young women contributes to reliance on commercialized sex, where the mobility of young men leads to instability in sexual partnerships and frequent partner change, or where women lack the ability to negotiate their fertility with spouses. It appears that even focused programs of testing and counselling with HIV-positive women in Europe and in Africa have not motivated a significant change in reproductive action. Were there a demonstrable effect of counselling on the fertility choices of infected persons, there are numerous practical limitations on the role that interventions can play in affecting the fertility of HIV-positive people.
PIP: There is some concern that people infected with HIV, upon learning of their HIV serostatus, may try to accomplish unmet reproductive goals knowing that they will not live a normal lifespan. This concern derives from the centrality of reproduction to life courses, adult identities, and access to social support, especially for women, in many African settings. However, should populations rush to complete their desired fertility in the wake of confirmed HIV-positive serostatus, health care providers, policymakers, communities, and the offspring of these individuals will have to bear the burden of eventual orphanage, being infected perinatally with HIV, and the long- and short-term provision of health care. This paper explores the potential effects of AIDS on fertility and reproductive decisions in East and Central Africa. The issue is seen in an integrated framework of biological, epidemiologic, and cultural contexts, and the prevailing conditions of response to the epidemic. There are many practical limitations to what can be done to affect the fertility of HIV-seropositive people.