'Pregnancy comes accidentally - like it did with me': reproductive decisions among women on ART and their partners in rural Uganda
1 Global Health Sciences, University of California, San Francisco, 50 Beale St, San Francisco, CA 94105, USA
2 Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
3 Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention (CDC), Entebbe, Uganda
BMC Public Health 2011, 11:530 doi:10.1186/1471-2458-11-530Published: 5 July 2011
As highly active antiretroviral therapy (ART) restores health, fertility and sexual activity among HIV-infected adults, understanding how ART influences reproductive desires and decisions could inform interventions to reduce sexual and vertical HIV transmission risk.
We performed a qualitative sub-study among a Ugandan cohort of 1,000 adults on ART with four purposively selected categories of participants: pregnant, not pregnant, delivered, and aborted. In-depth interviews examined relationships between HIV, ART and pregnancy, desire for children, perceived risks and benefits of pregnancy, decision-making regarding reproduction and family planning (FP) among 29 women and 16 male partners. Analysis focused on dominant explanations for emerging themes across and within participant groups.
Among those who had conceived, most couples stated that their pregnancy was unintentional, and often occurred because they believed that they were infertile due to HIV. Perceived reasons for women not getting pregnant included: ill health (included HIV infection and ART), having enough children, financial constraints, fear of mother-to-child HIV transmission or transmission to partner, death of a child, and health education. Most women reported FP experiences with condoms and hormonal injections only. Men had limited FP information apart from condoms.
Counselling at ART initiation may not be sufficient to enable women who do not desire children to adopt relevant family planning practices. On-going reproductive health education and FP services, with emphasis on the restoration of fertility after ART initiation, should be integrated into ART programs for men and women.