Considering childbearing in the age of highly active antiretroviral therapy (HAART): Views of HIV-positive couples

Abstract

Objectives : Based on a qualitative study conducted in Bulawayo, Zimbabwe, this article examines how the availability of HAART since April 2004 may impact the views and choices of HIV-positive couples on childbearing. Methods : In-depth interviews were conducted with 15 couples where at least one partner was HIV positive. All respondents were of reproductive age and had or were confronting reproductive and sexual decision-making. Results : HAART seems to have had a profound impact on the subject of childbearing among those who still desire to have children. Where hitherto individuals had only a desire for a child many are now, as a result of the availability of HAART, actively planning to have one. HAART has not only transformed their physical state but it has also transformed mostly what had been desire into intention. The impact, however, has not been uniform. Some respondents still desired to have a child but were not yet convinced about the efficacy of HAART in preventing vertical transmission. Some respondents felt that HAART may have a negative impact on the foetus and as such were against childbearing by HIV-positive people. No respondent indicated that their desire or intention to have a child had been extinguished by the advent of HAART. Conclusion : Based on the findings of the study, HAART seems to have had a differential but nonetheless significant role in the reproductive plans of HIV-positive couples. The study also notes that there is a need to make available complete and unbiased information on HAART, mother-to-child transmission risk (MTCT) and pregnancy to HIV-positive couples so as to enable them to make informed decisions.

Fertility Desires and Intentions and the Relationship to Consistent Condom Use and Provider Communication regarding Childbearing among HIV Clients in Uganda

“…The rates of participants who expressed a desire to have children (31%) and have a plan to bear a child in the near future (24%) are similar to what other studies have found in sub-Saharan Africa [1,4,8–12]. Furthermore, nearly one in five participants reported either parenting in the past year or about to parent a child.…”

“…Accordingly, reproductive health programs emphasize preventing pregnancies and use of contraceptives, including consistent condom use [7]. However, this approach does not account for the fact that 20–50% of PLHIV in sub-Saharan Africa want to have children [1,4,8–12]. Childbearing desires may at least partially explain why many PLHIV do not consistently use condoms [13,14], even in the context of serodiscordant relationships where there is a clear risk of horizontal transmission.…”

Stigmatising Attitudes among People Offered Home-Based HIV Testing and Counselling in Blantyre, Malawi: Construction and Analysis of a Stigma Scale

“…This was not probed further in the current study but may reflect, first, the prominence during post-test counselling given to family planning and the need to avoid unprotected sex to prevent HIV super-infection even within concordant HIV-positive couples and, secondly, widespread awareness about the risk of mother-to-child transmission of HIV resulting from recent scale-up of programs to prevent mother to child transmission of HIV (PMTCT). Previous studies among health workers [26] and the general population [27] that have found that fear of mother-to-child transmission is common and that blame may be apportioned to pregnant women by health workers and members of the general community. However, the right to have children is enshrined under Article 16 of the Universal Declaration of Human Rights [28], and so the high rate of agreement to such a strongly worded statement is concerning and suggests that PLWHA are still subject to discrimination, albeit less crude than in the early days of recognition of the HIV epidemic.…”

Fertility and HIV following universal access to ART in Rwanda: a cross-sectional analysis of Demographic and Health Survey data

“…The improved individual health through the availability of ART may result in improved sexual drive, influencing the behavior of HIV seropositive women [18]. Women on treatment may feel healthier, more optimistic about the PMTCT interventions, more positive about their own and children’s futures, and therefore engage in unprotected sexual activity and be more inclined to become pregnant [19]. …”