As HIV infection is managed more as a chronic rather than fatal condition in the U.S., HIV-infected bisexual and heterosexual men and women increasingly acknowledge their intentions to have children. This poses challenging public health concerns. The attempt to have children may increase HIV transmission to sexual partners who do not use condoms when trying to conceive. Additionally, HIV infected women who become pregnant risk HIV transmission to the fetus. Although some HIV-infected men and women seek reproductive medical assistance to reduce HIV transmission risks to partners, these services remain largely inaccessible in the U.S.; furthermore, their HIV status may restrict them from adopting children. Despite these public health concerns, very little research has examined the reproductive decision making processes, psychosocial experiences surrounding intentional childbearing, and HIV sexual risk taking behaviors of HIV- infected men and women. The proposed research will obtain in-depth interview data from a sample of 40 HIV positive bisexual and heterosexual men and women who have, after HIV diagnosis, planned pregnancies (intentional childbearing), 20 of whom have achieved pregnancies and 20 of whom have been unsuccessful in achieving pregnancy. Participants will be privately interviewed to document their intentional childbearing experiences including the types of conception strategies used, frequency of use, what they know about HIV transmission, how they make decisions to have a child, whether they have engaged in unprotected intercourse to conceive a child, and how these experiences impact their day-to-day activities.
The specific aims of this study are to: 1) Describe the psychosocial antecedents and experiences of intentional childbearing decisions among heterosexual and bisexual HIV-infected men and women, and to 2) Develop a theoretical model of how reproductive decision making processes influence the behavioral risk of horizontal HIV transmission. Data will be analyzed using grounded theory techniques, a process of joint collection, coding, and analysis of the data that allows for the basic social structural processes and meaning of a phenomenon to emerge. This project will generate preliminary data that can serve as the foundation for a R01 proposal to test the emergent theoretical model in a broader U.S. population of HIV-infected men and women. The study will also offer practical insights for HIV service and care providers of how HIV-infected men and women navigate the ethical and psychological strains around the decision to have children without harming the health of themselves or their partners and children. Finally, this study will help public health workers improve the effectiveness of HIV prevention programs by developing appropriate HIV interventions that take into account people's fertility motivations for engaging in HIV risk-taking behaviors. ? ? ? ?
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