Safer Conception for Couples Affected by HIV

Structural and Cultural Considerations in the Delivery of Safer Conception Care in Uganda

Published in: AIDS and Behavior , Volume 21, Issue 8 (August 2017), pages 2488 - 2496. doi: 10.1007/s10461-017-1816-4

Posted on RAND.org on August 03, 2017

by Deborah Mindry, Rhoda K. Wanyenze, Jolly Beyeza-Kashesya, Mahlet Atakilt Woldetsadik, Sarah Finocchario-Kessler, Kathy Goggin, Glenn Wagner

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In countries with high HIV prevalence and high fertility desires, the rights of HIV-affected couples to have children are a pressing issue. Conception among people living with HIV carries risks for both horizontal and vertical HIV transmission. In Uganda ~100,000 HIV-infected women become pregnant annually. Providers face a number of challenges to preventing HIV transmission, reducing unplanned pregnancies, and ensuring safer conception. We report findings from interviews with 27 HIV-affected couples (54 individuals) in Uganda. We explored key cultural and structural factors shaping couples' childbearing decisions. Our data reveal a complex intersection of gender norms, familial expectations, relationship dynamics, and HIV stigma influencing their decisions. Participants provided insights regarding provider bias, stigma, and the gendering of reproductive healthcare. To reduce horizontal transmission HIV and family planning clinics must address men's and women's concerns regarding childbearing with specific attention to cultural and structural challenges.

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