The intimate connection between HIV/AIDS and infertility is another key reason to consider infertility a public health concern. In the Infertility Belt HIV/AIDS and infertility rates are the highest in the world representing
twin threats for depopulating central and southern Africa. This connection has recently brought infertility to the attention of international health policy makers.
HIV/AIDS is a risk factor for infertility and these two devastating conditions are linked in a complex web of sexual and reproductive harm. In a quest for pregnancy, infertile women are more likely to engage in unprotected sexual intercourse; this behavior places them at increased risk of HIV. In parts of Africa infertile women are 2.5 times more likely than pregnant women to be HIV positive. Unprotected intercourse also increases the risk of acquiring other STIs, which can facilitate HIV infection and increase a woman’s risk of becoming infertile. Infertility and HIV/AIDS are connected in both cause and consequence. Efforts to reduce the rates of HIV infections need to consider the needs and behaviors of infertile women. HIV and infertility also have interconnected social effects which threaten women’s health.
A 1999 study in Cote d’Ivoire found that sexual and reproductive behaviors depend more on emotional and relational factors than on health conditions, and social pressures to have children were so great that women were often willing to risk becoming HIV infected themselves, infecting their partners, or giving birth to an HIV-infected child in order to become mothers. The health of an individual or couple and the risk of having an infected infant were often considered less important than the need to meet personal, familial and social obligations to have children.
A woman’s marital status, and in turn her health, can be effected by infertility and HIV. Many infertile women in sub-Saharan Africa experience multiple marriages and divorces, putting them at increased risk for acquiring HIV or other STIs with each new sexual partner. Infertility-induced divorce or abandonment can force women into bar work or prostitution where their risk of acquiring HIV is increased. Finally, husbands seeking to prove their fertility can introduce HIV infection to an infertile wife through extramarital sexual relationships.
Sexual behaviors and STIs are predictors of both infertility and HIV/AIDS infection in sub-Saharan Africa, and it is recommended that infertility prevention be integrated with HIV/AIDS campaigns. Reproductive and sexual knowledge could be beneficial in preventing both infertility and HIV/AIDS. The linkages between these conditions require that infertility receive attention as a significant public health concern.
