Response to HIV Decline in Zimbabwe: 10/19

While this was not the primary topic of the article on HIV decline in Zimbabwe, I was struck by the fact that HIV infection reduces fertility in women and chose to explore why that is the case. According to infoforhealth.org, studies show that the impact of HIV infection on female fertility is greatest in women at later stages of HIV infection and in women with high viral loads. However, pregnancy itself has not been shown to increase the rate of progression of HIV/AIDS. According to a United Nations report on HIV/AIDS and fertility in Sub-Saharan Africa, fertility rates in infected women are 25-40% lower than in uninfected women. The report also states that this lower fertility rate is largely due to biological mechanisms, rather than behavioral mechanisms. Biological mechanisms affecting fertility in HIV infected women include decreased sperm count in men, effects of co-infection with other sexually transmitted infections, and higher rates of both early and late fetal loss in infected women. While it is not surprising that HIV, which so dramatically affects the immune system and is tied to the reproductive system, would impact fertility in a biological manner, the United Nations report analyzes several behavioral factors in reduced fertility as well, which I found interesting. The ways in which HIV infection changes sexual behavior and fertility desires are numerous and complex, adding yet another element to the factors affecting the spread of the disease.

I also found it very interesting that the article on HIV decline asserted that HIV prevalence rates are “insensitive to behavior change” due to the lengthy incubation period of HIV infection. Thus the goal of attaining accurate data concerning the affect of behavioral interventions on HIV prevalence is very difficult to achieve, for prevalence rates and positive behavioral changes do not necessarily correlate.