A grounded theory study of childbearing decision-making among HIV-positive women

Background: ARVs can significantly reduce the risk of perinatal transmission of HIV, and have transformed HIV into a chronic illness in the U.S. However, some women living with HIV may be reluctant to bear children because of stigma against it. The purpose of this study is to examine the factors that influence HIV-positive women's childbearing decision-making. Methods: Participants were recruited in San Francisco, and included women over the age of 18 who had ever been pregnant since their diagnosis. In-depth interviews were conducted with eight women (data collection is ongoing), and were transcribed and coded for salient themes. Grounded theory methods were used to examine the decision-making factors and process. Results: The average age of the participants was 43 years old. Most had been diagnosed with HIV for over 10 years, and were currently on ARVs. Participants presented a range of experiences since HIV diagnosis, including planned and unplanned pregnancies, as well as loss of children to social services. Participants had experienced some stigma related to childbearing as HIV-positive women, and were very aware of "public opinion" regarding HIV-positive women. Healthcare providers were very important in their decisions about whether or not to bear children. Conclusions: A number of factors were identified as influencing childbearing decisions among these women, including the availability of ARVs, stage of acceptance of their HIV status, and the opinions of healthcare providers. Providers must be aware of these factors and their own role in helping HIV-positive women achieve their reproductive goals.