Women who risk HIV to get babies

By GATONYE GATHURA

Kenya: Most couples in relationships where only one individual is infected with HIV are opting for pregnancy.

The pattern is alarming because it means they are having unprotected sex, and risk passing on the virus to their unborn children and uninfected partners.

According to a team of medical researchers, the powerful desire to have children in such unions in Kenya is so overwhelming for such couples that it far outweighs the risk of infecting the unborn child.

Uninfected partner.

“This is a serious challenge in a country with an estimated 340,000 discordant couples most of whom have strong desires to have a first or a next child,” says Kenneth Ngure of Jomo Kenyatta University.

The team, which included researchers from Kenyatta National Hospital and the University of Washington, US, investigated 18 discordant couples attending a HIV research programme in Thika, Central Kenya.

The couples were participating in a study where the uninfected partner was put on a daily antiretroviral pill to see whether having the medication in the bloodstream would protect them against infection.

During the trials, Dr Ngure explains, all participants received counselling on how to reduce the risk of HIV infection, free condoms, and had access to contraceptives.

“Although most of the couples were aware of the increased risk of virus transmission, almost all reported that they had intentionally become pregnant and that the desire for children superseded any HIV risk considerations,” said Ngure.

Planned pregnancies

All but one couple in the study was married and the majority had at least one child before conceiving in the current situation.

“It emerged very clearly that these pregnancies were not accidental but deliberate, with couples mutually agreeing to discontinue the use of contraceptives including condoms in order to get pregnant,” explained Ngure.

Talking to The Standard yesterday about the findings published in the journal Aids Care, Ngure said the desire to have the first or another child is very strong in these unions normally called discordant couples. 

The observations suggest that simply encouraging such couples to abstain from having children is not realistic because, they knowingly take on the risks of transmission in order to have children.

One of the major reasons for wanting children, explains the researchers — especially among couples where the only child or children are from another union — is the desire for the other partner to have his or her own biological children.

Other reasons include the desire to reach a preferred family size as well as maintaining partnership stability, especially for women. Some couples also said they needed the next child to name after one’s parents, a common custom in the region.

Although the researchers are unanimous that the decision to have a child was mutual, a deeper look into the study shows that this may not to be the case with a significant power balance tilting towards the males.

When the desire to have a child in such a relationship is strongest in the woman, as it was the case in the study, then she has to nimbly negotiate, persuade and plead to bring the man along.

However, when the shoe is on the other foot, the man is said to have intimidated, threatened and did not fall short of using some strong language.

In such discussions, words such as “must,” and “force” coupled with threats of abandonment if the female partner did not agree to bear more children, are reflected in the study.

Divine protection

In addition to satisfying the desire to get a child and the pressure of societal expectations, many of the case study couples said they felt helpless and vulnerable.

“Uninfected partners were relieved when they remained uninfected after unprotected sex, which for some, reinforced a belief in divine protection,” says Ngure.

Having been exposed to such a high calibre research programme, the 18 couples had access to information on technologies that can reduce the risk of HIV transmission to the partner.

Such strategies, explains the lead researcher, include couples being shown how they can harvest sperm, in case of uninfected male, which the woman can inseminate into herself at home.

Others include the much more expensive test-tube baby technology as well as sperm washing in case of an infected male.