In order to further assess the relationship between these variables, a simple linear regression of HIV Prevalence vs. Ever Use of Injections was conducted and resulted in a significant positive correlation (p-value: 0.0002358, Adjusted R-squared: 0.4577). This regression is shown in Figure 2.
Discussion
The link between HIV and fertility represents key missing knowledge in the global health and development sector (Gregson 1993). My research found a significant negative correlation between HIV-seropositive status and fertility in women of reproductive age in Sub-Saharan Africa, as shown in Figure 1. This negative correlation supports the hypothesis that viral infections such as HIV have a negative impact on a woman’s fertility. The reasons for this negative correlation occurring in the Demographic and Health Surveys data may be widely varied and likely include physiological and behavioral reasons.
One weakness of this analysis is the fact that many confounding variables likely contribute to the negative correlation between HIV and fertility, most of which are impossible to control for within the bounds of available data. Thus, it is difficult to pinpoint exactly why this significant negative correlation between HIV positive status and fertility was found, but it is unlikely that it was due to a single variable, and likely involved both biological predictors, such as life-history trade offs and co-infections, as well as behavioral changes a HIV-infected individual may make, including making the decision not to attempt pregnancy. For this reason, more research must be done on the true relationship between viral infections as a physiological predictor of fertility.
Additionally, my research found that when the modifier of injectable contraceptive use was included in my analysis of the relationship between HIV positive status and fertility, the negative relationship between these two variables was rendered insignificant. This effect signals that any correlation between fertility and HIV prevalence cannot be disentangled from both variables’ association with injectable contraceptive use. These results suggest first that there is a negative association between fertility and injectable contraceptive use, which we should expect, since injectable contraceptives are a highly effective form of pregnancy prevention. Second, they suggest that there is also an association between HIV positive status and the modifier of injectable contraceptive use, supporting past data that injectable contraceptives may increase susceptibility to HIV through a physiological response.
This research supports previous findings that viral infections, particularly HIV, likely lead to reduced fertility among women. However, the inclusion of the modifying variable of injectable contraceptive use which led to a non-significant correlation between HIV and fertility demands that more research on the link between contraceptive choice, HIV, and fertility be conducted. The Population Institute and similar organizations are conducting meaningful research on the link between injectable contraceptives and HIV risk, but this research should be put into the context of HIV’s negative correlation with fertility. In order to best treat HIV-seropositive women, we must know if their ability to reproduce is affected by their viral status. With this knowledge, fertility assistance can be integrated into HIV treatment, and population health researchers will be able to best predict the effects of the “fertility transition” in Sub-Saharan Africa. In a broader sense, the effect of any viral infection on a woman’s fertility will have significant implications for treatment and intervention. Though straightforward relationships between variables have not been found in this study, the results provide an important jumping-off point for conversations regarding fertility and viral infection.
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Acknowledgements
I thank Charles Nunn for his guidance on this project, Jordan Anderson for statistical advice, and my classmates for their feedback as I constructed my research goals. This research was supported by Duke University's Global Health and Evolutionary Anthropology Departments and by the course Biology 385- Primate Disease Ecology and Global Health.
References
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