Reproductive decision-making in the context of HIV and AIDS: A qualitativestudy in Ndola, Zambia

Context: As the AIDS epidemic continues to spread in Sub-Saharan Africa, in creasing numbers of women of childbearing age and their partners have becom e infected with HIV: Family planning programs potentially can reduce perina tal and heterosexual transmission, but effective programmatic strategies de pend on how HIV and AIDS influence reproductive decisionmaking. Methods: in 1997, eight focus groups and 23 in-depth interviews were conduc ted among women and men in Ndola, Zambia, an area with a high prevalence of HIV and AIDS. Coded transcripts and summary matrices permitted substantive themes to be analyzed by gender of study participants. Results: In the absence of signs or symptoms of illness, HIV's impact on wo men's and men's childbearing and contraceptive use decisions is generally w eak. One important exception is the study participants' observation of the burden of caring for children whose parents have died of AIDS. However, whe n signs or symptoms of the illness are present, both women and men are over whelmingly against continued childbearing and support the use of condoms to prevent transmission of the disease to a spouse. Many women said they woul d fear getting pregnant if they suspected they were HIV positive because pr egnancy would "bring out" the disease, and some women said that before havi ng another child they would consider taking an HIV test. Conclusions: Family planning programs could help clients ascertain their ow n risk of infection and thus reduce perinatal transmission of HIV by frankl y discussing risk factors, offering HIV testing and assisting couples affec ted by HIV make better choices about contraceptive methods.