Sexuality, reproduction, and HIV in women: the impact of antiretroviral therapy in elective pregnancies in Cuba.
OBJECTIVE
Since HIV was first diagnosed in Cuba in 1985 to the end of 2006, 246 HIV-positive women have given birth to 266 children; of these, more than half were born after 2001, when antiretroviral therapy (ART) became widely available in Cuba. The objective of the study was to explore how the provision of ART free at point of delivery to all clinically indicated patients might be related to the rapid increase in pregnancies in HIV-positive women.


METHODS
: A qualitative instrument was designed to assess how reproductive and sexual histories were affected by a diagnosis of HIV and by the availability of ART.


METHODS
Data were collected from 55 women, representing 26% of HIV-positive women who are known to have given birth in Cuba. A structured interview was used to collect qualitative information on women's reproductive and sexual histories.


RESULTS
Sixty-four per cent of women interviewed reported becoming pregnant aware of their HIV status or that of their partner; of these, all except one became pregnant after ART became widely available in Cuba. The majority said their worries about transmitting HIV subsided after talking to doctors, obtaining information on mother-to-child transmission, learning they could receive ART and deliver by Cesarean section to reduce the risk of vertical transmission significantly, and meeting HIV-positive women who had HIV-negative children.


CONCLUSIONS
The introduction of effective therapy for HIV, by transforming the social and clinical course of HIV/AIDS and allowing the possibility of having HIV-negative children, contributes to decrease HIV/AIDS-related fear and stigma and reshape reproduction.
Castro
Arachu
A
Department of Social Medicine, Harvard Medical School, Boston, MA 02115, USA. arachu_castro@hms.harvard.edu
Khawja
Yasmin
Y
González-Núñez
Ida
I
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000600:supply & distribution* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001294:Attitude to Health; D003462:Cuba / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D043762:Reproductive Behavior; D019529:Sexuality
D019380:Anti-HIV Agents