Abstract
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.
Highlights
Infertility can affect anywhere between 8 - 12% of a population worldwide
While infertility is socially significant in many cross-cultural contexts such as Botswana, it remains less visible in the face of the HIV and AIDS epidemic and hardly considered in the literature on partner selection in those contexts
HIV status is important in the decisions that couples living with HIV make in terms of who they will marry and with whom they will have children
Summary
Infertility can affect anywhere between 8 - 12% of a population worldwide. In cross-cultural contexts and in the African continent, these estimates can vary widely evidence suggests a notable central and southern African infertility belt stretching from Namibia to Mozambique. While infertility is socially significant in many cross-cultural contexts such as Botswana, it remains less visible in the face of the HIV and AIDS epidemic and hardly considered in the literature on partner selection in those contexts. In this southern African nation, there is some evidence to suggest that patients do voice concerns over fertility and positive status but there remains a dearth of information on how those fears or decisions are ameliorated. The cultural perception of health [4], actual increases in longevity and participation in unsafe sexual practices as a result of ARV therapy [5,6,7]; including multiple concurrent partnerships, unprotected sex in order to facilitate pregnancy and negate infertility, all contribute to any further reduction in incidence or prevalence rates in Botswana
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