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

HIV-1 seroprevalence rates in women attending prenatal clinics in Kampala; Uganda

The objective was to determine the HIV-1 seroprevalence in expectant women in Kampala. HIV-1 antibody status (by ELISA -Cambridge Biotech; with comformatory ELISA-Wellcozyme on positives); obstetric and socio-demographic characteristics were determined on a random proportionate to-size sample of 1002 expectant consenting women seeking care at 11 prenatal units in Kampala between august and December of 1993. HIV-1 age-specific rates were determined. Chi-square analysis; tests for linear trend in rates and 95CI were used to determine significance of seroprevalence rates. Results showed overall seroprevalence of HIV-1 for the study population (mean age = 22.4 years; range = 14 - 42 years) was 20.5(95CI:18.0; 23.1); with the highest age-specific rate of 28.55 occurring at 20 - 22 years. An increasing trend of rates was observed between 14 - 24 years (p0.0001); followed; thereafter; by a decreasing trend (p

HIV-1 seroprevalence rates in women attending prenatal clinics in Kampala; Uganda. (p.96)

The objective was to determine the HIV-1 seroprevalence in expectant women in Kampala. HIV-1 antibody status (by ELISA -Cambridge Biotech; with comformatory ELISA-Wellcozyme on positives); obstetric and socio-demographic characteristics were determined on a random proportionate to-size sample of 1002 expectant consenting women seeking care at 11 prenatal units in Kampala between august and December of 1993. HIV-1 age-specific rates were determined. Chi-square analysis; tests for linear trend in rates and 95CI were used to determine significance of seroprevalence rates. Results showed overall seroprevalence of HIV-1 for the study population (mean age