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Open Access Research article

'Pregnancy comes accidentally - like it did with me': reproductive decisions among women on ART and their partners in rural Uganda

Rachel King12*, Kenneth Khana3, Sylvia Nakayiwa3, David Katuntu3, Jaco Homsy1, Pille Lindkvist2, Eva Johansson2 and Rebecca Bunnell3

Author Affiliations

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

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BMC Public Health 2011, 11:530  doi:10.1186/1471-2458-11-530

Published: 5 July 2011

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords:
HIV; ART; Uganda; HIV-infected persons; Africa; reproductive intentions