Introduction
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Human Immunodeficiency Virus (HIV) most commonly affects women in their reproductive years, defined generally as the ages between 15 and 49.  As a result, many HIV-seropositive women consider having offspring, as do women of reproductive age infected with other viral infections. Examining the effect of viral infections on fertility is essential in order to consider a woman’s fertility needs as a key treatment goal in interventions to remedy viral disease. More specifically, the link between HIV and fertility is important to examine in Sub-Saharan Africa because the HIV/AIDS epidemic and the “fertility transition”, a shift from high to low birth rates, co-exist in most regions of Sub-Saharan Africa.  The HIV/AIDS epidemic in Sub-Saharan Africa has contributed to cyclical poverty, increased mortality of women and children, high numbers of orphaned children, deterioration of the health and economic sectors, and reduced agricultural output. Individually, HIV and fertility have substantial effects on socio-economic development and health. By uncovering if HIV has a negative effect on fertility for women in Sub-Saharan Africa, researchers will be able to best craft interventions and predict mortality and population dynamics. 
HIV is thought to have a negative influence on fertility for several interacting reasons.  First, viral infections in general have been shown to have biological effects which may contribute to declining fertility rates, likely due to life history trade-offs, meaning that the body must put significant energy towards fighting off a viral infection, leaving less energy resources available for successful reproduction.  Additionally, HIV increases a woman’s risk for amenorrhea, miscarriage, and other co-infections which can make birth more risky or impossible.  To a lesser extent, it is predicted that knowledge of one’s HIV positive status may contribute to a decreased desire for pregnancy.  
Previous studies have shown positive correlations between HIV and reduced fecundity both at the individual and population level, but given the wide range of confounding social and environmental factors, causation is difficult to prove. Most studies which have shown a significant decrease in fertility rates among women who are infected with HIV focus on community-level analyses, as confounding variables abound when examining population level and country-level data, including regional differences in fertility. In a population-level study of the effect of HIV on fertility, Juhn et al. found that HIV contributed to a 20-25% decrease in fertility rate among women.  This decrease was attributed to direct physiological effects, changes in sexual behavior, and unwillingness to engage in risky sex. 
As shown by this background research, multiple intersecting factors may contribute to the relationship between HIV and fertility.  One possible confounding factor of particular interest to population health researchers is that of injectable contraceptive use. A recent meta-analysis conducted in collaboration with the Population Research Institute reviewed a total of 24 studies published in peer-reviewed journals and found a significant increased risk of acquiring HIV when using Depo-Provera and other injectables. The possible effect of injectable contraception methods on HIV risk would have major implications for international health interventions, as injectable contraceptives are currently the most-used form of long-acting reversible contraception used in Sub-Saharan African countries with high rates of HIV/AIDS.  If injectable contraceptives do pose an increased risk of HIV, the ethics of promoting such contraceptives as a solution to unwanted pregnancies must be immediately considered. Injectable contraceptive use, based on this information, is an essential modifier to consider when examining the link between HIV infection and fertility, due to its possible relationship with both variables.
Based on this prior data, I hypothesize that viral infections reduce female fertility due to life history trade-offs and increased susceptibility for co-infections.  To investigate this hypothesis, I will make the prediction that there is a there is a significant negative correlation between HIV seropositive status and fertility rate among women of reproductive age. In addition, I will investigate if injectable contraceptive use modifies this relationship between HIV and fertility.