Fertility Intentions among Kenyan Couples after HIV Diagnosis: A Qualitative Investigation

Mellissa Withers, University of California, Los Angeles
Sara J. Newmann, University of California, San Francisco
Elizabeth A. Harrington, Oregon Health & Science University
Zachary Kwena, Kenya Medical Research Institute (KEMRI)
Elizabeth A. Bukusi, Kenya Medical Research Institute (KEMRI)
Craig R. Cohen, University of California, San Francisco

BACKGROUND: The impact of HIV on fertility intentions in sub-Saharan Africa is not well-understood. METHODS: In-depth interviews were conducted with 25 HIV sero-concordant, married couples in Nyanza Province, Kenya to explore how HIV affects fertility desires. RESULTS: HIV compelled men and women to alter fertility plans, both promoting and reducing childbearing intentions. Despite large family-size norms, many intended to stop childbearing, prompted by fears of early death, financial difficulties, health concerns, stigma, and potential mother-to-child transmission. DISCUSSION: Fertility intentions of HIV-positive individuals are driven by both individual concerns, and societal and cultural expectations. HIV-positive couples may require additional support and services to achieve their fertility goals. Counselling on contraception and prevention of mother-to-child transmission can help couples to make informed decisions about childbearing options. Community-wide education programs could help dispel myths and reduce stigma associated with HIV and childbearing.