All ETDs from UAB

Advisory Committee Chair

Susan L Davies

Advisory Committee Members

Diane M Grimley

Bradley E Lian

Linda Moneyham

Katharine E Stewart

Document Type

Dissertation

Date of Award

2009

Degree Name by School

Doctor of Philosophy (PhD) School of Public Health

Abstract

One-quarter of adults living with HIV/AIDS in the US are women, most of whom are facing decisions regarding their reproductive future. Despite clear challenges and complexities facing HIV-positive women, most research suggests that they maintain strong desires and intentions for motherhood. This research explores the correlates of desire for another child, with a specific emphasis on examining the relationship between current parenting experiences and future childbearing desires, among a predominantly black sample of HIV-positive women (n=96) participating in the Making Our Mothers Stronger (MOMS) Project. Predictors of contraceptive use and consistency between contraceptive practices and fertility desires are also explored among sexually active respondents (n=44). Modifications to a theoretical framework of fertility decision-making are proposed to advance the study of fertility among US women living with HIV/AIDS. Sixty-nine percent of respondents reported no desire for, 20% expressed some desire for, and 12% expressed ambivalence about future childbearing. Few parenting experience indicators were found to correlate with childbearing desires and none remained significant following multivariate analyses. After controlling for the effects of other variables, partner's childbearing desires, participation in private religious practices and parity were the only factors significantly associated with childbearing desires. Over 70% of the sample reported using contraception to prevent pregnancy; however, suboptimal contraceptive use remained. Childbearing desires were not significantly associated with contraceptive practices. Following multivariate analyses, parity, child-related stress, past 30 day alcohol consumption, and a forgiving disposition were significantly associated with various indicators of contraceptive use to prevent pregnancy. The Fertility Decision-Making model, or Traits-Desires-Intentions-Behavior (TDIB) framework, was identified as a promising theoretical framework for the study of reproductive decision-making and behavior among this population. Extant research supports the application of a couple-level TDIB framework with modifications to address the likely influence of HIV transmission beliefs, personal health status and disease progression, and experiences of HIV-related stigma on the formation of childbearing intentions and reproductive behaviors among women living with HIV/AIDS. Such an application, building on present results, will facilitate greater understanding of the fertility desires and experiences of HIV-positive women along with improved reproductive counseling and care for HIV-positive women and their partners.

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