BACKGROUND: Sixty percent of new HIV infections in Uganda occur in stable relationships between HIV discordant couples. Given the importance of fertility in Uganda, we hypothesized that unsafe sexual practices may be used to found a family/replace a dead child. Thus, we explored sexual practices to understand to what extent these are influenced by the desire to have children and the implications for HIV transmission among discordant couples. METHODS: A cross-sectional survey of 114 HIV discordant couples in Kampala, and in-depth interviews with 15 purposively selected couples. Quantitative data were analysed using STATA. Multivariate logistic regression analysis done to identify factors associated with consistent condom use. Thematic content analysis of qualitative data was done using NVIVO 2. RESULTS: Participants wanting children and those with multiple sexual partners were less likely to use condoms (Adj OR 0.51, and 0.36 respectively). Three of the five types of sexual practices used by couples do not allow pregnancy to occur. Main reasons for wanting a child included: ensuring lineage continuity and posterity, securing relationships and pressure from relatives to reproduce. Challenges included: risk of HIV transmission to partner and child, lack of negotiating power for safer sex, failure of health systems to offer safe methods of reproduction CONCLUSIONS: HIV sero-discordant couples with strong desire for childbearing have a dilemma of risking HIV infection or infecting their spouse. Some risk transmission of HIV infection to reproduce. We need to address gender issues, risky behaviour and reproductive health services for HIV sero-discordant couples.
BACKGROUND: Sixty percent of new HIV infections in Uganda occur in stable relationships between HIV discordant couples. Given the importance of fertility in Uganda, we hypothesized that unsafe sexual practices may be used to found a family/replace a dead child. Thus, we explored sexual practices to understand to what extent these are influenced by the desire to have children and the implications for HIV transmission among discordant couples. METHODS: A cross-sectional survey of 114 HIV discordant couples in Kampala, and in-depth interviews with 15 purposively selected couples. Quantitative data were analysed using STATA. Multivariate logistic regression analysis done to identify factors associated with consistent condom use. Thematic content analysis of qualitative data was done using NVIVO 2. RESULTS:Participants wanting children and those with multiple sexual partners were less likely to use condoms (Adj OR 0.51, and 0.36 respectively). Three of the five types of sexual practices used by couples do not allow pregnancy to occur. Main reasons for wanting a child included: ensuring lineage continuity and posterity, securing relationships and pressure from relatives to reproduce. Challenges included: risk of HIV transmission to partner and child, lack of negotiating power for safer sex, failure of health systems to offer safe methods of reproduction CONCLUSIONS: HIV sero-discordant couples with strong desire for childbearing have a dilemma of risking HIV infection or infecting their spouse. Some risk transmission of HIV infection to reproduce. We need to address gender issues, risky behaviour and reproductive health services for HIV sero-discordant couples.
Entities:
Keywords:
HIV Sero-discordance; condom use; desire for children
Authors: Susan Allen; Jareen Meinzen-Derr; Michele Kautzman; Isaac Zulu; Stanley Trask; Ulgen Fideli; Rosemary Musonda; Francis Kasolo; Feng Gao; Alan Haworth Journal: AIDS Date: 2003-03-28 Impact factor: 4.177
Authors: Kate S Wilson; George Wanje; Linnet Masese; Jane M Simoni; Juma Shafi; Lucy Adala; Julie Overbaugh; Walter Jaoko; Barbra A Richardson; Raymond S McClelland Journal: J Acquir Immune Defic Syndr Date: 2018-07-01 Impact factor: 3.731
Authors: Jolly Beyeza-Kashesya; Anna Mia Ekstrom; Frank Kaharuza; Florence Mirembe; Stella Neema; Asli Kulane Journal: BMC Public Health Date: 2010-05-13 Impact factor: 3.295
Authors: Nelly R Mugo; Ting Hong; Connie Celum; Deborah Donnell; Elizabeth A Bukusi; Grace John-Stewart; Jonathan Wangisi; Edwin Were; Renee Heffron; Lynn T Matthews; Susan Morrison; Kenneth Ngure; Jared M Baeten Journal: JAMA Date: 2014 Jul 23-30 Impact factor: 56.272