ESTIMATION OF HIV PREVALENCE USING FERTILITY EXPERIENCE OF WOMEN OF REPRODUCTIVE AGE IN NIGERIA

Abstract

Use of sentinel site to obtain HIV/AIDS data on pregnant women attending antenatal clinic in Nigeria shows that the prevalence rate of HIV has steadily been on the increase with recent decline to 5.0% in 2003 and 4.4% in 2005 and 4.1%. Also the results of a population based survey conducted in 2007 by Federal Ministry of Health estimated overall adult prevalence of HIV/AIDS at 3.6 %. It is however unclear if this represents a true decrease in the prevalence considering the differences in the methods employed by ANC sentinel survey and NARHS. Due to the fertility variability among women especially among those of child bearing age who present at the ANC, there is always need for their fertility adjustment. One of such adjustment is the relative age-specific fertility rates of women who are HIV-positive compared with those of their HIV-negative peers. This study therefore compared the fertility of HIV positive and HIV negative women of reproductive age to know if the ANC HIV - estimate underestimate, overestimate or approximately estimate the HIV burden of the general population. This was the comparative cross sectional, population based study that used data from 5360 women of reproductive age who participated in 2007 National HIV/AIDS –and Reproductive Health Survey in Nigeria. Data were analyzed using bivariate and logistic regression. Of the total number, 170 (4.1%) were HIV positive. The mean age for all HIV positive women was 29.65 (± 8.476) compared to 27.88 (± 9.4) years for HIV negative women. Of all the women who visited ANC, 4.8% of them were HIV positive and 2.8% of those who were HIV positive have not visited any ANC. On the other hand, of all the women who had had ANC visit, 95.2% of them were HIV negative while 97.2% of those who are negative have not had any ANC visit (p =0.024). The fertility rate for HIV positive (365.7 births per 1000 women years of exposure, 95% Cl 293 to 438) was higher than that of HIV negative women (360.15 births per 1000 women years of exposure, 95% of 354 to 375). The overall RIR was 1.015 (95% CI 1.00 to l.0 I 8). This finding was consistent with studies in West African countries. This study conclusively found that ANC HIV prevalence estimate overestimated HIV prevalence in Nigeria. Formally married women and never married women were high risk groups because marital status was found to be an influencing factor contributing to HIV status determination. This study therefore strongly recommends that continous monitoring of the fertility rates in HIV positive and HIV negative women of reproductive age should be adjunct to HIV serosurveillance because fertility rates are not static, but change overtime. Attention muct be given to women who are formally married or never married by sensitizing them on the need to know their HIV status and programmes that target this group regarding HIV prevention and its management should be strengthened.