Abstract
ABSTRACTThe effectiveness of antiretroviral treatment has reduced sexual HIV transmission and mother-to-child-transmission. To optimally support women living with HIV, health care providers need deepened knowledge about HIV, sexuality and childbearing. The aim of this study was to describe the phenomenon sexuality and childbearing as experienced by women living with HIV in Sweden. Data were collected by phenomenon-oriented interviews with 18 HIV-positive women. A reflective lifeworld analysis based on phenomenological philosophy was conducted, describing the meaning structure of the phenomenon. The essence of the phenomenon is that perceptions about HIV and its contagiousness profoundly influence sexual habits and considerations in relation to pregnancy and childbearing. These perceptions are formed in combination with knowledge and interpretations about HIV by the women themselves and by their environments. The essence is further described by its constituents: Risk of transmission imposes demands on responsibility; The contagiousness of HIV limits sexuality and childbearing; Knowledge about HIV transmission provides confident choices and decisions; and To re-create sexuality and childbearing. Although HIV has a low risk of transmission if being well treated, our study shows that HIV-positive women feel more or less contagious, which influences sexuality and decision-making in relation to become pregnant and give birth.
Highlights
Sexuality and childbearing are integral parts of health and being a woman and, by ensuring that women have access to sexual and reproductive health services with good quality, these elements can contribute to fulfilling and strengthening women’s human rights (World Health Organization [WHO], 2013)
The aim of this study was to describe the phenomenon sexuality and childbearing as it is experienced by women living with HIV in Sweden
The phenomenon sexuality and childbearing, as it is experienced by women living with HIV in Sweden, was explored by using the reflective lifeworld approach based on phenomenological philosophy as described by Dahlberg, Dahlberg, and Nyström (2008)
Summary
Sexuality and childbearing are integral parts of health and being a woman and, by ensuring that women have access to sexual and reproductive health services with good quality, these elements can contribute to fulfilling and strengthening women’s human rights (World Health Organization [WHO], 2013). Women living with HIV have important, specific sexual and reproductive health-related needs (Patterson et al, 2017). Increased access to antiretroviral treatment (ART) and starting early with ART after diagnosis has, together with the effectiveness of ART, reduced mortality and morbidity in HIV-positive people (Nakagawa et al, 2012; Van Sighem, Gras, Reiss, Brinkman, & De Wolf, 2010). The effectiveness of ART has reduced the risk of transmission to a sexual partner (Cohen et al, 2011; Wawer et al, 2005), a risk which is even questioned to be possible when an individual is well treated with ART (Rodger et al, 2016). ART during pregnancy, suppressing plasma HIV RNA, and mothers refraining from breastfeeding the baby have been found to significantly reduce the risk of motherto-child-transmission (MTCT) to a level below 0.5% in well treated individuals (Mandelbrot et al, 2015; Swedish Reference Group for Antiviral Therapy [RAV], 2017)
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