The dilemma of safe sex and having children: challenges facing HIV sero-discordant couples in Uganda.

TLDR

Sixty percent of new HIV infections in Uganda occur in stable relationships between HIV discordant couples. The study aimed to examine how fertility desires influence unsafe sexual practices and HIV transmission risk among discordant couples in Uganda, and to address gender, risky behavior, and reproductive health service gaps. A cross‑sectional survey of 114 discordant couples and in‑depth interviews with 15 couples were conducted, with quantitative data analyzed in STATA and multivariate logistic regression to identify factors linked to condom use, and qualitative data analyzed via NVIVO 2. Couples desiring children or having multiple partners were less likely to use condoms (adjusted OR 0.51 and 0.36), and although three of five sexual practices prevented pregnancy, motivations for childbearing included lineage continuity, relationship security, and social pressure, while challenges such as HIV transmission risk, limited negotiating power, and inadequate reproductive health services heightened the dilemma of risking infection for childbearing.

Abstract

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.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.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 reproductionHIV 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.