BMC Public Health Research article Association between fertility and HIV status: what implications for HIV estimates? Eugene J Kongnyuy*1 and Charles S Wiysonge2 BioMed Central Open Access Address: 1Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK and 2South African Cochrane Centre, South African Medical Research Council, Cape Town, Republic of South Africa Email: Eugene J Kongnyuy* - kongnyuy@gmail.com; Charles S Wiysonge - wiysonge@yahoo.com * Corresponding author Published: 11 September 2008 BMC Public Health 2008, 8:309 doi:10.1186/1471-2458-8-309 This article is available from: http://www.biomedcentral.com/1471-2458/8/309 Received: 27 April 2008 Accepted: 11 September 2008 © 2008 Kongnyuy and Wiysonge; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Most estimates of HIV prevalence have been based on sentinel surveillance of pregnant women which may either under-estimate or over-estimate the actual prevalence in adult female population. One situation which can lead to either an underestimate or an overestimate of the actual HIV prevalence is where there is a significant difference in fertility rates between HIV- positive and HIV-negative women. Our aim was to compare the fertility rates of HIV-infected and HIV-uninfected women in Cameroon in order to make recommendations on the appropriate adjustments when using antenatal sentinel data to estimate HIV prevalence Methods: Cross-sectional, population-based study using data from 4493 sexually active women aged15 to 49 years who participated in the 2004 Cameroon Demographic and Health Survey. Results: In the rural area, the age-specific fertility rates in both HIV positive and HIV negative women increased from 15–19 years age bracket to a maximum at 20–24 years and then decreased monotonically till 35–49 years. Similar trends were observed in the urban area. The overall fertility rate for HIV positive women was 118.7 births per 1000 woman-years (95% Confidence Interval [CI] 98.4 to 142.0) compared to 171.3 births per 1000 woman-years (95% CI 164.5 to 178.2) for HIV negative women. The ratio of the fertility rate in HIV positive women to the fertility rate of HIV negative women (called the relative inclusion ratio) was 0.69 (95% CI 0.62 to 0.75). Conclusion: Fertility rates are lower in HIV-positive than HIV-negative women in Cameroon. The findings of this study support the use of summary RIR for the adjustment of HIV prevalence (among adult female population) obtained from sentinel surveillance in antenatal clinics. Background The prevalence of Human Immunodeficiency Virus (HIV) is a measure of disease burden which is important in eval- uating HIV prevention programmes and in designing new preventive strategies. Most estimates of HIV prevalence in developing countries have been based on sentinel surveil- lance of pregnant women [1]. HIV prevalence among pregnant women in antenatal clinics (ANC) closely approximates HIV prevalence in the adult population. ANC data is sometimes used to estimates HIV prevalence in general female population, instead of the general adult population (both males and females). This assumption is, however, unfounded [2]. Women who adopt abstinence or correct and consistent condom use in response to HIV Page 1 of 7 (page number not for citation purposes)