Reproductive needs of men and women living with HIV: implications for family planning counselling

Abstract

This research explored the reproductive needs of people of low socio-economic standing living with HIV/AIDS (PLWHA) and attending public health facilities in South Africa. A qualitative research design based on the theoretical framework of critical realism using grounded theory was employed in revealing the dominant unobserved underlying mechanisms, powers and structures that influence their reproductive decision-making. HIV-positive men, HIV positive pregnant women and HIV positive non-pregnant women were recruited by HIV counsellors from the Ante-Natal Clinic and the Voluntary Counselling and Testing Clinic at the Kalafong Hospital. Individual interviews were used to explore participants’ reproductive needs. Focus group discussions were employed to holistically explore the HIV counsellors’ attitudes and perceptions regarding their clients’ reproductive needs and future family planning. Parenthood was an important factor to all participants in establishing their gender identities. Different cultural norms existed for men and women realising their reproductive needs. Society expects of women to be mothers, yet at the same time negatively judges HIV-positive women who choose to become pregnant or refuse to abort an existing pregnancy. Consequently, most women choose not to disclose their status and continue to live as if they are not HIV-positive. Having children is so important to these reproductive-aged PLWHA that they will risk their own health, the health of their partners and their babies. Emancipatory transformation of current HIV counselling services is needed and can be established by improving counsellor knowledge through training as well as giving PLWHA access to accredited HIV risk reducing services.