The growing HIV epidemic among women, parallel epidemic of pediatric AIDS, and increasing use of prenatal therapy to prevent vertical HIV transmission focuses critical attention on the outcomes of HIV-infected women's reproductive decisions. Yet the process and determinants of these reproductive decisions have been little studied or systematically evaluated. This study uses qualitative methods to a) develop an ethnographic profile of HIV-infected women's reproductive decision- making; and b) identify and link multiple levels of influence on their reproductive decisions.
Specific Aims will generate in-depth understanding of HIV-infected women and 1) key individual and social factors that influence their reproductive decisions; 2) external conditions that impact their reproductive choices or ability to exercise those choices; and 3) the impact of existing policies intended to reduce vertical HIV transmission and of clinical advances (such as prenatal therapy) on their reproductive decisions. In-depth interviews are conducted with HIV-infected women and their care providers. Participant observation is conducted with a sub-sample of women chosen for case interest and theoretical relevance. Levels and pathways of influence on reproductive decisions are analyzed based on a Conditional Matrix. The synthesis of in-depth case study data and broad contextual understanding will generate grounded theoretical hypotheses to address the specific aims. The results of this research will fill information gaps on HIV-infected women's reproductive decision-making, inform existing policies and interventions targeting HIV-infected women, and identify areas for further qualitative and quantitative research.