Abstract:
The availability of antiretroviral treatment (ART) is enabling people living with HIV
or AIDS (PLWHA) to reconsider their sexual and reproductive lives. The sexual and
reproductive health (SRH) decisions that PLWHA make have implications for HIV
transmission and prevention. Yet very little is known about SRH of PLWHA in subSaharan
Africa, as studies as well as prevention strategies have historically neglected
them and SRH matters are often not part of HIV/AIDS treatment and care services.
This study looks at how HIV-positive men and women negotiate their sexual and
reproductive lives and the barriers to the realisation of SRH needs in Nairobi slums.
This study employs a mixed methods study design involving both quantitative (survey
n=513) and qualitative (in-depth interviews n=41 and key informant interviews n=14).
Respondents were systematically recruited from the community in two slums in
Nairobi for quantitative interviews, a subset of which was followed on for in-depth
interviewing. Quantitative analyses include univariate, bivariate and multivariate
logistic regression modelling. Qualitative data were transcribed, and coded and
thematically analysed. SRH outcomes of the study include sexual activity/inactivity,
condom use, multiple sexual partnerships, fertility intentions, contraceptive use and
unmet need for family planning. Quantitative and qualitative components of the entire
study are integrated throughout both analysis and interpretation.
The findings show that the SRH outcomes of PLWHA are somewhat different from
the general population, but similar with other PLWHA in similar settings. Condom use
at last sex is high although consistent use is an issue. PLWHA exhibit fertility desires
and contraceptive behaviour that is more geared towards limiting fertility, but face
barriers, and hence the high unmet need for contraception. The SRH outcomes are
shaped by demographic (e.g. age, parity), socio-cultural (gender, societal norms)
relationship (disclosure, intimacy, pleasure) and health factors (ART use, duration of
HIV and side-effects and health concerns).Their SRH outcomes are reflective of their
efforts for social approval. However, there is a conflict between social validation and
moral pressures for HIV prevention presenting a dilemma to many about “proper”
SRH behaviour in the ART era. There is need to include SRH counselling and services
as part of the standard HIV treatment and care services for PLWHA.
