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Safer Conception for Couples Affected by HIV: Structural and Cultural Considerations in the Delivery of Safer Conception Care in Uganda

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Abstract

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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Acknowledgements

We acknowledge the extraordinary efforts of the providers, interviewers (Joseph Kyebuzibwa and Jacque Nakitende), and all of our colleagues at TASO Jinja and TASO Mulago who assisted in this study.

Funding

This study was supported by an NICHD Grant, R01 HD072633.

Author information

Authors and Affiliations

  1. Center for Culture and Health, Semel Institute, University of California, Los Angeles, 760 Westwood Plaza, Box 62, Los Angeles, CA, 90024, USA

    Deborah Mindry

  2. Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda

    Rhoda K. Wanyenze

  3. Mulago Hospital Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda

    Jolly Beyeza-Kashesya

  4. Pardee RAND Graduate School, 1776 Main St., Santa Monica, CA, 90407, USA

    Mahlet A. Woldetsadik

  5. Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA

    Sarah Finocchario-Kessler

  6. Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, USA

    Kathy Goggin

  7. Schools of Medicine and Pharmacy, University of Missouri, Kansas City, USA

    Kathy Goggin

  8. RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA

    Glenn Wagner

Authors
  1. Deborah Mindry
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  2. Rhoda K. Wanyenze
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  3. Jolly Beyeza-Kashesya
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  4. Mahlet A. Woldetsadik
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  5. Sarah Finocchario-Kessler
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  6. Kathy Goggin
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  7. Glenn Wagner
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Corresponding author

Correspondence to Deborah Mindry.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Mindry, D., Wanyenze, R.K., Beyeza-Kashesya, J. et al. Safer Conception for Couples Affected by HIV: Structural and Cultural Considerations in the Delivery of Safer Conception Care in Uganda. AIDS Behav 21, 2488–2496 (2017). https://doi.org/10.1007/s10461-017-1816-4

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  • DOI: https://doi.org/10.1007/s10461-017-1816-4

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