Efforts to eliminate
mother-to-child transmission of
HIV in
Tanzania are guided by a four-prong strategy advocated by the
World Health Organization (
WHO). Prong 2, prevention of
unintended pregnancies among
women living with HIV, has, however, received the least
attention and
contraceptive use to prevent
unintended pregnancies remains low. This study explored the perceived barriers to the use of modern
methods of
contraception, and factors influencing
contraceptive choice among
HIV-positive
women in urban Dar-es-Salaam,
Tanzania. A qualitative multi-site study was conducted, utilising in-depth interviews and
focus group discussions with 37 sexually active
HIV-positive
women aged between 20 and 44 years, attending three
health facilities within Dar-es-Salaam. The theoretical framework was a
patient centred model. Four barriers were identified the influence of the
women's spousal relationships; personal
beliefs and the relationship of these in
understanding her disease; the influence of the social demands on the
woman and her relationships; and the importance of a
woman's relationship with her
healthcare provider/healthcare system. Being the bearers of bad news (
HIV-positive status) the
pregnant women experienced conflicts,
violence, abandonment and rejection. The loss in
negotiating power for the
women was in relation to their intimate partners, but also in the
patient
healthcare provider relationship. The
role of the
male partner as a
barrier to
contraceptive use cannot be understated. Therefore, the results suggest that
healthcare providers should ensure
patient-focused
education and provide support that encompasses the importance of their relationships. Additional
research is required to elucidate the functional
association between
contraceptive choices and personal and
social relationships