15th International AIDS Conference Bangkok, Thailand — July 11-July 16, 2004

Int Conf AIDS. 2004 Jul 11-16;15:Abstract No. LbOrD29

B Gombachika Chimphamba
University of Bergen, Bergen, Norway

BACKGROUND: There is scant knowledge on the experiences of pregnant HIV positive women; their reproductive choices, their reflections about health and future for themselves and their children, and their actual handling of their precarious condition. This study aimed to generate knowledge to be applied by health service providers in planning policies and practices to improve reproductive choices and health care of HIV-positive pregnant women.

METHODS: In-depth interviews were conducted (October 2003) with twelve HIV-positive pregnant women attending two antenatal clinics in Lilongwe, Malawi. The women were part of a project linked to a University of North Carolina (UNC) Prevention of mother to child transmission of HIV (PMTCT) project. The qualitative interviews explored the lived experiences of HIV-positive pregnant women.

RESULTS: The majority (9 out of 12) of the informants reported learning about their HIV-positive status after becoming pregnant, and had not considered themselves to be at risk of HIV. They expressed feelings of shock, disbelief, and anger towards their spouses as a reaction to the HIV result. All feared telling their husbands about the result, and expressed the need to include husbands in counseling sessions. Three of the informants did not disclose their HIV-positive diagnosis to anyone. The ones who did disclose their status all experienced some support from their spouses. Regarding pregnancy decisions two were forced by their husbands to have a child (one woman knew her HIV-positive status before becoming pregnant), three wished to please their husbands (two woman knew their HIV-positive status before becoming pregnant), one became pregnant following default to a modern method of contraception, while the rest had wished to become pregnant). Only one woman wished to discontinue the pregnancy. Though all of the informants expressed at the time of the interview (now enrolled in the PMTCT project) that they did not wish to have more children, the large majority (10 out of 12) were not sure about the strategies they would employ to prevent having more children. Upon the HIV-positive diagnosis, only two of the informants were employing condoms with their spouses.

All informants expressed substantial fear of transmitting HIV to the child through breast-feeding, and the dreaded situation of leaving their children orphaned comprised their prime worry. The informants expressed tangible need for support groups for HIV-positive pregnant women.

CONCLUSIONS: Socio-cultural obligations to have children appeared to outweigh the fears and risks associated with the prospects of deteriorating health, the risk of giving birth to infected infants, and as well as the fear of leaving children orphaned. Improved intervention strategies and diverse forms of support groups for HIV-positive pregnant women which can address issues of pregnancy decision making as well as coping and disclosure are in urgent demand. The issue of disclosure would be substantially eased by including spouses in counseling sessions.

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LbOrD29

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