Antiretroviral Therapy Helps HIV-Positive Women Navigate Social Expectations for and Clinical Recommendations against Childbearing in Uganda

Abstract

Understanding factors that influence pregnancy decision-making and experiences among HIV-positive women is important for developing integrated reproductive health and HIV services. Few studies have examined HIV-positive women's navigation through the social and clinical factors that shape experiences of pregnancy in the context of access to antiretroviral therapy (ART). We conducted 25 semistructured interviews with HIV-positive, pregnant women receiving ART in Mbarara, Uganda in 2011 to explore how access to ART shapes pregnancy experiences. Main themes included: (1) clinical counselling about pregnancy is often dissuasive but focuses on the importance of ART adherence once pregnant; (2) accordingly, women demonstrate knowledge about the role of ART adherence in maintaining maternal health and reducing risks of perinatal HIV transmission; (3) this knowledge contributes to personal optimism about pregnancy and childbearing in the context of HIV; and (4) knowledge about and adherence to ART creates opportunities for HIV-positive women to manage normative community and social expectations of childbearing. Access to ART and knowledge of the accompanying lowered risks of mortality, morbidity, and HIV transmission improved experiences of pregnancy and empowered HIV-positive women to discretely manage conflicting social expectations and clinical recommendations regarding childbearing.

Medication adherence in pregnant women with human immunodeficiency virus receiving antiretroviral therapy in sub-Saharan Africa: a systematic review

“… (specific short course antiretroviral regimen not mentioned) 61 PLA (3male, 3 female groups with 8–12 participants): 30 IDIs (16 HIV + &5 HIV – women, 6 HCWs, 3 health officials. **** 8 Kastner, et al 2014 [ 51 ] Uganda: Urban IDIs Women attending HIV clinic for follow up (HIV + pregnant women in their 2ND AND 3RD trimester. (cART) IDIs:25 pregnant women *** 9 *Murithi, et al 2015 [ 41 ] Kenya: IDIs HIV + women pregnant receiving care in a PMTCT clinic.…”

Mothers living with HIV: replacing breastfeeding by infant formula

“…A Canadian research has considered as disquieting the poor communication of health professionals as well as how infant feeding in the context of HIV is conducted, especially without the necessary care regarding the social and emotional aspects of the mother (6) . Studies have shown that effective guidelines for women with HIV should start before pregnancy even to address aspects of reproductive health and HIV transmission (26) , and that it has been a challenge to overcome health system weaknesses and…”

A discussion of key values to inform the design and delivery of services for HIV‐affected women and couples attempting pregnancy in resource‐constrained settings

“…Prevailing social and structural barriers may impact HIV-affected women and couples’ ability to utilize HIV and reproductive health services. For example, optimizing pre-pregnancy maternal health is important for pregnancy planning but may be a lower priority for women, particularly in socio-cultural and normative gendered contexts where pressures and expectations to bear children are high [ 27 ]. Where women have limited autonomy over reproductive decision-making, the delays involved in testing and treating pre-existing conditions or infections before pregnancy attempts occur may create difficulties for women.…”