Drug regimens and procedures now exist that will prevent parents from transmitting HIV to infants, and the ethical and legal obligation to promote and protect the reproductive rights of those living with HIV should form part of training for HIV/AIDS care and prevention. This paper reports a study that investigated issues of sexuality and reproduction with 250 Brazilian men living with HIV in São Paulo. We asked whether they wished to have children and whether health professionals in HIV/AIDS treatment clinics that they attended were supportive of their wishes. Health professionals were not considered by most participants to be supportive enough or even impartial about HIV-positive people having children, and paid little attention to men's fathering role. 80% of the men had sexual relationships, and 43% of them wanted children, especially those who had no children, in spite of expectations of disapproval. Few of the men received information about treatment options that would protect infants, however. In previous studies with HIV-positive women attending the same clinics, by comparison, greater knowledge about prevention of perinatal HIV transmission was reported, but women had fewer sexual relationships, fewer desired to have children, and they expected even more disapproval of having children from health professionals. We conclude that the rights of those with HIV to found a family depend as much on curing the ills of prejudice and discrimination, including among health professionals, as on medical interventions.

Links between HIV/AIDS care and reproductive health, including fertility options for people living with HIV (PLWH), have not been sufficiently addressed by health care providers. Moreover, few studies have addressed men in this regard. To describe attitudes toward parenthood and identify factors associated with desire to have children among men and women living with HIV a cross-sectional study involving a sample of 533 women and 206 men (bisexual and heterosexual) attending two reference sexually transmitted disease (STD)/AIDS centers in São Paulo, Brazil. Participants answered a standardized questionnaire. Desire to have children as the study outcome was compared between men and women and associated factors searched for in multivariable regression analysis. In contrast to previous studies conducted in developed countries, desire to have children in this sample was more frequent among men than among women and it was reported by 27.9% of participants (50.1% of men versus 19.2% of women). Women were more likely to anticipate doctors' strong opposition to PLWH getting pregnant and men reported lower information level about HIV/mother-to-child transmission (MTCT). Bisexual men were more likely to desire to have biologic children. Male gender, younger age, having no children, living with 1-2 children, and being in a heterosexual partnership were independently associated with desire to have children. Regardless of gender, the childless as well as the youngest should be regarded as groups to be particularly targeted by counseling, to be provided with objective information about reproductive rights and options. Further research is warranted to address the desire for children among strictly homosexual men.

OBJETIVOS: compreender o significado da experiência de não amamentar e as razões que levam as mães a seguirem tal recomendação. MÉTODOS: estudo qualitativo onde a fenomenologia social foi tomada como referencial teórico-metodológico. O grupo estudado consistiu em 17 mães de um ambulatório infantil. Algumas mães eram HIV positivo, algumas apresentavam um status de infecção não determinado. Utilizou-se o método de análise de conteúdo. RESULTADOS: entre as razões destacadas para não amamentar, foram identificados sentimentos de não se considerarem completas e valorizadas como mães. Vivenciar a não-amamentação implica na reestruturação da relação mães/bebê, traz preconceitos e discriminação. A não-amamentação é uma forma de impedir a infecção do bebê pelo HIV e uma forma de eximir-se de culpa, obtendo assim perdão da sociedade. CONCLUSÕES: os resultados mostram que "não amamentar" - conduta indentificada pelo enfaixamento dos seios - é considerado doloroso e punitivo. Envolve o desejo de manter sadio o bebê e, mais do que aspectos biológicos, implica em questões sociais, culturais e emocionais. Parecem indicar ainda falta de atenção dos profissionais da área da saúde ao sentimento das mães, quando essas enfrentam o dilema da não-amamentação.

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