Loss and regeneration: influences on the reproductive decisions of HIV positive, drug-using women.

Current approaches to the reduction of perinatal transmission of HIV infection among drug-using women focus on the content of counseling sessions which may include suggestions to abstain from sexual intercourse, to use barrier contraceptives, or to terminate pregnancy. The broader social and cultural issues which may influence some HIV positive women's decisions to have children (such as prolonged, unwanted separation from existing children; the need for appropriate drug treatment; empowerment through educational and vocational opportunities; and the meanings associated with motherhood, children, and HIV/AIDS) are not addressed in these efforts. This study of the reproductive decisions and meanings associated with children and motherhood among drug-using, female methadone patients describes some of the social and cultural influences on reproductive decisions. The findings suggest that discontinuous mother-child coresidence; locally produced theories of perinatal transmission; and the culturally constructed meanings associated with motherhood and children influence decisions to bear children among HIV infected, drug-using women. Relevant policy issues are discussed.