The Dilemma of Safe Sex and Having Children: Challenges Facing HIV Sero-Discordant Couples in Uganda

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

The Effects of Enhanced Access to Antiretroviral Therapy : a Qualitative Study of Community Perceptions in Kampala city; Uganda

Introduction: Since 2001; Antiretroviral Therapy (ART) has been integrated as part of the Uganda National Program for Comprehensive HIV/AIDS Care and Support. If patients take Antiretroviral drugs (ARVs) as prescribed; quality of life is expected to improve and patients become healthier. It is; however; postulated that scale up of ARVs could erode the previous achievement in behaviour change interventions. This study examined community perceptions and beliefs on whether enhanced access to ARVs increases risk beha-viour. It also examined people's fears regarding HIV/AIDS infection and the use of ARVs. Methods: This was a qualitative study that utilized Focus Group Discussions (FGDs) and Key Informant (KI) interviews. Participants were purposefully sampled. Twenty FGDs comprising of 190 participants and 12 KI interviews were conducted. FGDs were conducted with adult men and women (above 25 years); and youth (male and female) while KI interviews were held with Kampala City Council officials; Kawempe Division Local Council officials; health workers and religious leaders. All data was tape recorded with consent from participants and transcribed thereafter. Typed data was analyzed manually using qualitative latent content analysis technique. Results: Most participants felt that enhanced access to ART would increase risky sexual behaviour; namely promiscuity; lack of faithfulness among couples; multiple partners; prostitution; unprotected sexual practices; rape and lack of abstinence as the risky sexual behaviours. A few FGDs; however; indicated that increased ART access and counselling that HIV-positive people receive promoted positive health behaviour. Some of the participants expressed fears that the increased use of ARVs would promote HIV transmission because it would be difficult to differentiate between HIV-positive and HIV-negative persons since they all looked healthy. Furthermore; respondents expressed uncertainty about ARVs with regard to adherence; sustainable supply; and capacity to ensure quality of ARVs on the market Con- clusions: There are fears and misconceptions that enhanced access to ART will increase risky sexual behaviour and HIV transmission. Information Education and Communi-cation (IEC) on ART use and availability should be enhanced among all people. Prevention programs which are modified and specific to the needs of the people living with HIV should be developed and implemented; and should include information on the ability of individuals to transmit HIV even when they are on ART