People living with HIV (PLHIV) continue to have children after being diagnosed with HIV, yet little research attention has been paid to actual lived childbearing experiences of PLHIV post-HIV diagnosis. We interviewed 10 HIV-positive women and 11 HIV-positive men in Iringa, Tanzania, about their experiences of conceiving and having children after being diagnosed with HIV. We adopted an approach to data analysis based on grounded theory and phenomenology. Participants’ experiences were shaped by social and institutional factors. Some participants reported pressures to bear children by partners and relatives, whereas others reported negative reactions from others concerning their pregnancies. Most participants had not discussed having children with a provider before attempting to conceive. Some reported being reprimanded by health providers for getting pregnant without seeking their advice. Consideration of support systems and challenges surrounding the childbearing experiences of PLHIV can help inform reproductive health interventions for those who desire children.
AaronE.CohanD. (2013). Preexposure prophylaxis for the prevention of HIV transmission to women. AIDS, 27, F1–F5. doi:10.1097/QAD.0b013e32835917b4
2.
BerhanY. (2008). Attitude of people living with HIV/AIDS to be a biological parent and their knowledge on MTCT reduction methods. Ethiopian Medical Journal, 46, 335–347.
3.
BrownG. G.HuttA. M. B. (1935). Anthropology in action: An experiment in the Iringa district of the Iringa province, Tanganyika territory. London: Oxford University Press.
4.
ChadwickR. J.MantellJ. E.MoodleyJ.HarriesJ.ZweigenthalV.CooperD. (2011). Safer conception interventions for HIV-affected couples: Implications for resource-constrained settings. Topics in Antiviral Medicine, 19, 148–155.
5.
CharmazK. (2006). Constructing grounded theory: A practical guide through qualitative analysis. London: Sage.
6.
CohenM. S.ChenY. Q.McCauleyM.GambleT.HosseinipourM. C.KumarasamyN.. . . FlemingT. R. (2011). Prevention of HIV-1 infection with early antiretroviral therapy. The New England Journal of Medicine, 365, 493–505. doi:10.1056/NEJMoa1105243
7.
CooperD.HarriesJ.MyerL.OrnerP.BrackenH. (2007). “Life is still going on”: Reproductive intentions among HIV-positive women and men in South Africa. Social Science & Medicine, 65, 274–283.
8.
DoyalL. (2000). Gender equity in health: Debates and dilemmas. Social Science & Medicine, 51, 931–939.
9.
DudgeonM. R.InhornM. C. (2004). Men’s influences on women’s reproductive health: Medical anthropological perspectives. Social Science & Medicine, 59, 1379–1395. doi:10.1016/j.socscimed.2003.11.035
10.
Finocchario-KesslerS.BastosF. I.MaltaM.AndersonJ.GogginK.SweatM.. . . KerriganD. (2012). Discussing childbearing with HIV-infected women of reproductive age in clinical care: A comparison of Brazil and the US. AIDS and Behavior, 16, 99–107. doi:10.1007/s10461-011-9906-1
11.
Finocchario-KesslerS.DariotisJ. K.SweatM. D.TrentM. E.KellerJ. M.HafeezQ.AndersonJ. R. (2010). Do HIV-infected women want to discuss reproductive plans with providers, and are those conversations occurring?AIDS Patient Care and STDs, 24, 317–323. doi:10.1089/apc.2009.0293
12.
FortesM. (1978). Parenthood, marriage and fertility in West Africa. Journal of Development Studies, 14, 121–148.
13.
GreenG.SoboE. J. (2000). The endangered self: Managing the social risk of HIV. London: Routledge.
14.
HeffronR.DonnellD.KiarieJ.ReesH.NgureK.MugoN.. . . BaetenJ. M. (2014). A prospective study of the effect of pregnancy on CD4 counts and plasma HIV-1 RNA concentrations of antiretroviral-naive HIV-1-infected women. Journal of Acquired Immune Deficiency Syndromes, 65, 231–236. doi:10.1097/QAI.0000000000000013
15.
InhornM. C.BalenF. V. (Eds.). (2002). Infertility around the globe: New thinking on childlessness, gender, and reproductive technologies. Berkeley: University of California Press.
16.
KaidaA.MatthewsL. T.KantersS.KabakyengaJ.MuzooraC.MocelloA. R.. . . BangsbergD. R. (2013). Incidence and predictors of pregnancy among a cohort of HIV-positive women initiating antiretroviral therapy in Mbarara, Uganda. PLoS ONE, 8(5), e63411. doi:10.1371/journal.pone.0063411
17.
KanniappanS.JeyapaulM. J.KalyanwalaS. (2008). Desire for motherhood: Exploring HIV-positive women’s desires, intentions and decision-making in attaining motherhood. AIDS Care, 20, 625–630. doi:10.1080/09540120701660361
18.
KikuchiK.WakasugiN.PoudelK. C.SakisakaK.JimbaM. (2011). High rate of unintended pregnancies after knowing of HIV infection among HIV positive women under antiretroviral treatment in Kigali, Rwanda. BioScience Trends, 5, 255–263.
19.
KingR.KhanaK.NakayiwaS.KatuntuD.HomsyJ.LindkvistP.. . . BunnellR. (2011). “Pregnancy comes accidentally—Like it did with me”: Reproductive decisions among women on ART and their partners in rural Uganda. BMC Public Health, 11, Article 530. doi:10.1186/1471-2458-1111-1530
20.
KisakyeP.AkenaW. O.KayeD. K. (2010). Pregnancy decisions among HIV-positive pregnant women in Mulago Hospital, Uganda. Culture, Health & Sexuality, 12, 445–454. doi:10.1080/13691051003628922
21.
LoutfyM. R.MargoleseS.MoneyD. M.GyslerM.HamiltonS.YudinM. H. (2012). Canadian HIV pregnancy planning guidelines. Journal of Obstetrics and Gynaecology Canada, 34, 575–590.
22.
MacCarthyS.LaherF.NdunaM.FarlaneL.KaidaA. (2009). Responding to her question: A review of the influence of pregnancy on HIV disease progression in the context of expanded access to HAART in sub-Saharan Africa. AIDS and Behavior, 13(Suppl. 1), 66–71. doi:10.1007/s10461-009-9541-2
23.
MaltaM.ToddC. S.StibichM. A.GarciaT.PachecoD.BastosF. I. (2010). Patient-provider communication and reproductive health among HIV-positive women in Rio de Janeiro, Brazil. Patient Education & Counseling, 81, 476–482. doi:10.1016/j.pec.2010.09.013
24.
MatthewsL. T.BaetenJ. M.CelumC.BangsbergD. R. (2010). Periconception pre-exposure prophylaxis to prevent HIV transmission: Benefits, risks, and challenges to implementation. AIDS, 24, 1975–1982. doi:10.1097/QAD.0b013e32833bedeb
25.
MatthewsL. T.SmitJ. A.Cu-UvinS.CohanD. (2012). Antiretrovirals and safer conception for HIV-serodiscordant couples. Current Opinion in HIV and AIDS, 7, 569–578. doi:10.1097/COH.0b013e328358bac9
26.
MayanjaB. N.ShaferL. A.Van der PaalL.KyakuwaN.NdembiN.HughesP.. . . GrosskurthH. (2012). Effect of pregnancy on immunological and virological outcomes of women on ART: A prospective cohort study in rural Uganda, 2004-2009. Tropical Medicine & International Health, 17, 343–352. doi:10.1111/j.1365-3156.2011.02921.x
27.
MinkoffH.HershowR.WattsD. H.FrederickM.ChengI.TuomalaR.. . . ThompsonB. (2003). The relationship of pregnancy to human immunodeficiency virus disease progression. American Journal of Obstetrics and Gynecology, 189, 552–559.
28.
MmbagaE. J.LeynaG. H.EzekielM. J.KakokoD. C. (2013). Fertility desire and intention of people living with HIV/AIDS in Tanzania: A call for restructuring care and treatment services. BMC Public Health, 13, Article 86. doi:10.1186/1471-2458-13-86
29.
MmejeO.CohenC. R.CohanD. (2012). Evaluating safer conception options for HIV-serodiscordant couples (HIV-infected female/HIV-uninfected male): A closer look at vaginal insemination. Infectious Diseases in Obstetrics and Gynecology, 2012, Article 587651. doi:10.1155/2012/587651
30.
MyerL.CarterR. J.KatyalM.ToroP.El-SadrW. M.AbramsE. J. (2010). Impact of antiretroviral therapy on incidence of pregnancy among HIV-infected women in Sub-Saharan Africa: A cohort study. PLoS Medicine, 7(2), e1000229. doi:10.1371/journal.pmed.1000229
31.
NattabiB.LiJ.ThompsonS. C.OrachC. G.EarnestJ. (2009). A systematic review of factors influencing fertility desires and intentions among people living with HIV/AIDS: Implications for policy and service delivery [Review]. AIDS and Behavior, 13, 949–968. doi:10.1007/s10461-009-9537-y
32.
OdutolaA.BaisleyK.HayesR. J.RusizokaM.TantonC.WeissH. A.. . . Watson-JonesD. (2012). Pregnancy and contraceptive use among women participating in an HIV prevention trial in Tanzania. Sexually Transmitted Infections, 88, 436–443. doi:10.1136/sextrans-2011-050412
33.
OtisoK. M. (2013). Culture and customs of Tanzania. Santa Barbara, CA: Greenwood.
34.
RingheimK. (2002). When the client is male: Client-provider interaction from a gender perspective. International Family Planning Perspectives, 28, 170–175.
35.
SchwartzS. R.ReesH.MehtaS.VenterW. D.TahaT. E.BlackV. (2012). High incidence of unplanned pregnancy after antiretroviral therapy initiation: Findings from a prospective cohort study in South Africa. PLoS ONE, 7(4), e36039. doi:10.1371/journal.pone.0036039
36.
SmithD. J.MbakwemB. C. (2007). Life projects and therapeutic itineraries: Marriage, fertility, and antiretroviral therapy in Nigeria. AIDS, 21(Suppl. 5), S37–S41. doi:10.1097/01.aids.0000298101.56614.af
37.
SmithJ. A. (2009). Interpretative phenomenological analysis: Theory, method and research (LarkinM. H.FlowersP., Eds.). Los Angeles: Sage.
38.
Tanzania Commission for AIDS, Zanzibar AIDS Commission, National Bureau of Statistics, Office of the Chief Government Statistician, & ICF International. (2013). Tanzania HIV/AIDS and Malaria Indicator Survey 2011-12. Dar es Salaam: Author.
39.
World Health Organization & United Nations Population Fund. (2006). Sexual and reproductive health of women living with HIV/AIDS: Guidelines on care, treatment and support for women living with HIV/AIDS and their children in resource-constrained settings. Geneva, Switzerland: World Health Organization.
40.
YeatmanS. (2011). “HIV is an enemy of childbearers”: The construction of local epidemiology in rural Malawi. Culture, Health & Sexuality, 13, 471–483. doi:10.1080/13691058.2011.552985
