Sub-Saharan Africa (SSA) has a disproportionate burden of both unintended fertility and HIV infection, but the relationship between these two reproductive health risks is not well understood. This paper investigates the association between HIV status and unintended (mistimed and unwanted) fertility and examines multilevel predictors and national variations of unintended fertility among HIV-positive women across countries in SSA. Multilevel multinomial logistic regression models are applied to Demographic and Health Surveys data collected during 2006–2014 from 25 countries of SSA. Overall findings reveal that across countries of SSA, pregnancies of HIV-positive women are, on average, less likely to be mistimed (RR = 0.90, p < 0.05) but more likely to be unwanted (RR = 1.18, p < 0.05), rather than wanted, compared to pregnancies among HIV-negative counterparts with similar characteristics. Besides, knowledge of HIV status is associated with lower unintended fertility among HIV-negative, but not HIV-positive women. At country level, higher HIV prevalence and testing coverage are associated with higher mistimed and unwanted, rather than wanted fertility. Interaction effects suggest different effect sizes between HIV-positive and HIV-negative women: pregnancies among HIV-positive women are more likely than those among HIV-negative women to be unwanted rather than wanted among those who know their HIV status, are of older age, are married, have higher parity or reside in rural areas. The results further reveal notable country effects on unintended fertility, depicting regional variations that mirror HIV prevalence—being highest in Southern Africa and lowest in Western/Central Africa.

撒哈拉以南非洲地区的意外生育和艾滋病毒感染负担过重，但是人们对这两种生殖健康风险之间的关系知之甚少。本文调查了艾滋病毒状态与意外（不适当的和不想要的）生育率之间的关联，并研究了SSA中各个国家的艾滋病毒呈阳性妇女的多层次预测因素和意外生育率的国家差异。多级多项逻辑回归模型适用于2006-2014年从撒哈拉以南非洲25个国家收集的人口与健康调查数据。总体调查结果表明，在撒哈拉以南非洲国家中，艾滋病毒呈阳性的妇女平均而言，时机错误的可能性较小（RR = 0.90，p  <0.05），但更可能是不受欢迎的（RR = 1.18，p）。 与具有类似特征的HIV阴性同行者的怀孕相比，<0.05）而不是希望。此外，对艾滋病毒状况的了解与艾滋病毒阴性但非艾滋病毒阳性妇女的意外生育率较低有关。在国家一级，较高的艾滋病毒流行率和检测覆盖率与较高的时机错误和不想要的而不是想要的生育率有关。相互作用的影响表明，HIV阳性妇女和HIV阴性妇女之间的效应大小不同：在HIV阳性妇女中，怀孕年龄比HIV阴性妇女中的怀孕更有可能是不想要的，而不是想要的人，已婚，具有较高的平均收入或居住在农村地区。结果进一步揭示了国家对意外生育的显着影响，