Health Care Experiences of HIV-Infected Women With Fertility Desires in Mexico: A Qualitative Study

Abstract

Increased access to antiretroviral therapy has enabled Mexican HIV-infected women to resume healthy sexual and reproductive lives and reduce the risk of mother-to-child transmission of HIV infection. However, little information is available on the experiences of HIV-infected women desiring children. In this qualitative study, we conducted in-depth interviews with 31 HIV-infected women in four Mexican cities. The findings indicated that most of the women were given limited information on their pregnancy options. With some exceptions, the women felt they were denied the option to have (or to have more) children and advised to undergo tubal ligations or abortions. The findings of this study indicate that ongoing efforts are needed to promote the reproductive rights of HIV-infected women in Mexico and to ensure that they receive options aligned with their fertility desires.

Motherhood and HIV: reproductive desire, ambivalent feelings and a/an (not) offered care

“…Feelings of women living with HIV regarding the possibility of motherhood and in the course of a pregnancy Motivation for reproduction: the desire to be mothers versus the desire postponed or abolished after the diagnosis of HIV infection (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)31) Fears and insecurities regarding the uncertainties regarding the clinical outcomes of effective gestation (13)(14)(15)(19)(20)(22)(23)(24)(25)(26)(27)(28)(29) Effective gestation produces feelings of hope, renewal and greater motivation for self-care (13,15,(19)(20)(24)(25)(26)(27)(29)(30) Care provided and not provided by health professionals to women living with HIV with regard to reproductive health as a right Support for reproductive decisions on safe means to effect the desire for pregnancy in fact or during prenatal care (19,21,23,(32)(33)(34) Disregard for the reproductive demands of women living with HIV (14)(15)(19)(20)(21)(24...…”

“…Besides VT (13,15) , women fear the acceleration of their disease progression and the possibility of dying, leaving their children alone (14)(15)(24)(25) . Add to this the fear of side effects of medication and of children suffering from prejudice and discrimination (15) , and concern that they cannot breastfeed (13) .…”

“…Even in the face of a still strongly present stigma, two qualitative studies in Thailand and Mexico show that women do not "give up" of the dream of being a mother. Children acquire a vital meaning, often becoming the main, if not the only, reason in the fight against the feeling of hopelessness so frequent in this population (24)(25) . The possibility of these being born without the virus constitutes a source of motivation for their own lives (15,30) , makes them feel renewed (19) , brings satisfaction and brings them to a moment of happiness with expectations of generating a healthy child (13,20,30) .…”

“…A qualitative study with 285 women with HIV in Latin American countries pointed out that health professionals, based on stigma and discrimination, annulled their reproductive rights, resulting in disinformation and denial of services to coerce women into accepting sterilization (36)(37) or counseling regarding abortion (25) . A study in Argentina states that unmet need for contraception is risky, as it may lead to discontinuation of unwanted pregnancies under unsafe conditions, resulting in increased risk due to immunological vulnerability (34) .…”

“…Most of the professionals and managers interviewed in research on specialized HIV care services in 26 Brazilian state capitals (39) stated that the counseling was focused mainly on the use of condoms and Antiretroviral Therapy and scarce counseling regarding reproductive planning or discussion about contraception (25,34,39) . In a study in Argentina, doctors categorically state that if other contraceptive options are offered, patients will stop using condoms, causing new infections or reinfections (34) .…”