Revista de SIDA e investigación clínica

HIV Prevention, Infertility and Concordance in Partner Selection among Couples Living with HIV and AIDS in Rural and Peri-Urban Contexts in Botswana

Abstract

Rebecca L. Upton

This paper examines marital partner selection and the significance of fertility status among couples living with HIV using qualitative research methods. This study was conducted in the Maun and Gaborone areas in Botswana in southern Africa where patrilineal marriage traditions are normative and both civil as well as traditional marriage practices remain prevalent. Data were collected from 32 respondents using in-depth interviews after new civil marriages and where HIV status was positive for both partners. Results from the research demonstrate that HIV status is socially significant in the decisions that the couples living with HIV make in terms of selecting marriage partners. Yet once new marital relationships are established based on concordant HIV status, the cultural importance of fertility and childbearing remains paramount and rates of unprotected sex remain high. HIV positive and concordant couples engaged in unprotected sex in order to reinforce positive social status through reproductive success even when knowledge about mother to child transmission and increased viral loads in their own bodies was evident. This paper demonstrates the value of understanding cultural norms that surround fertility desires and fears of infertility in crafting efficacious HIV prevention programmes. HIV concordant couples still seek fertility success with partners in a context where HIV infection rates have remained high and this paper contributes to literature on both partner selection with respect to HIV status as well as the value of qualitative investigation to elucidate cultural challenges to HIV prevention. The paper concludes with further recommendations for understanding of the often overlooked cultural significance of infertility in areas with high HIV infection in order to better inform policies in the formulation of evidence based prevention strategies in Botswana with respect to people living with HIV and AIDS.