My partner wants a child: A cross-sectional study of the determinants of the desire for children among mutually disclosed sero-discordant couples receiving care in Uganda

We conducted a survey among 114 mutually disclosed sero-discordant couples (228 individuals) receiving HIV care at four centres in Greater Kampala, between June and December 2007. The data we collected was classified according to whether the man or the woman was HIV-positive. We carried out multivariate logistic regression modelling to determine factors (age, gender, and the influences of relatives and of health workers, ART knowledge, and disclosure) that are independently associated with a desire for children.The majority, 59%, of the participants, desired to have children. The belief that their partner wanted children was a major determinant of the desire to have children, irrespective of the HIV sero-status (adjusted odds ratio 24.0 (95% CI 9.15, 105.4)). Among couples in which the woman was HIV-positive, young age and relatives' expectations for children were significantly associated with increased fertility desire, while among couples in which the man was positive; knowledge of ART effectiveness was associated with increased fertility desire. Availability of information on contraception was associated with decreased fertility desire.The gender of the positive partner affects the factors associated with a desire for children. Interventions targeting sero-discordant couples should explore contraceptive choices, the cultural importance of children, and partner communication.As the HIV pandemic matures, 75% of infected people are of reproductive age. In Africa, about 5 to 31% of married or cohabitating couples live in a sero-discordant relationship [1-5]. In Uganda, incidence modelling revealed that 43% of all new HIV infections in adults (15-49 years) in 2008 were among people in discordant monogamous relationships [6]. Millions of cohabiting couples do not know each other's HIV status, while sexual relationships remain a challenge in mutually disclosed sero-discordant couples [7]. The desire to have children, societal expectations, and stigmatization of both HIV