Abstract:
Objectives: Fertility desires require new understanding in a context of expanding access to antiretroviral therapy for people
living with HIV/AIDS in Sub-Saharan Africa. This paper studies the fertility desires and their rationales, of slum-dwelling
Kenyan men and women living with HIV/AIDS who know their serostatus, but have different antiretroviral therapy treatment
statuses. It addresses two research questions: How do people living with HIV/AIDS consider their future fertility? What
factors contribute to an explanation of fertility desires among people living with HIV/AIDS.
Methods: A mixed methods study (survey [n = 513] and in-depth interviews [n = 41]) with adults living with HIV/AIDS living
in Nairobi slums was conducted in 2010. Regression analyses assess independent relationships between fertility desires and
socio-demographic factors. Analyses of in-depth interviews are used to interpret the statistical analyses of fertility desires.
Results: Our analyses show that fertility desires are complex and ambivalent, reflecting tensions between familial and
societal pressures to have children versus pressures for HIV (re-)infection prevention. More than a third (34%) of men and
women living with HIV expressed future fertility desires; however, this is significantly lower than in the general population.
Factors independently associated with desiring a child among people living with HIV/AIDS were age, sex, number of
surviving children, social support and household wealth of the respondent.
Discussion: Increasing access to ART is changing the context of future childbearing for people living with HIV/AIDS.
Prevailing values mean that, for many people living with HIV/AIDS, having children is seen as necessary for a ‘‘normal’’ and
healthy adult life. However, the social rewards of childbearing conflict with moral imperatives of HIV prevention, presenting
dilemmas about the ‘‘proper’’ reproductive behaviour of people living with HIV/AIDS. The health policy and service delivery
implications of these findings are explored.
