title: The dilemma of safe sex and having children: challenges facing HIV sero-discordant couples in Uganda.
abstract: BACKGROUND
  Sixty percent of new HIV infections in Uganda occur in stable relationships between HIV discordant couples. Given the importance of fertility in Uganda, we hypothesized that unsafe sexual practices may be used to found a family/replace a dead child. Thus, we explored sexual practices to understand to what extent these are influenced by the desire to have children and the implications for HIV transmission among discordant couples.
  
  
  METHODS
  A cross-sectional survey of 114 HIV discordant couples in Kampala, and in-depth interviews with 15 purposively selected couples. Quantitative data were analysed using STATA. Multivariate logistic regression analysis done to identify factors associated with consistent condom use. Thematic content analysis of qualitative data was done using NVIVO 2.
  
  
  RESULTS
  Participants wanting children and those with multiple sexual partners were less likely to use condoms (Adj OR 0.51, and 0.36 respectively). Three of the five types of sexual practices used by couples do not allow pregnancy to occur. Main reasons for wanting a child included: ensuring lineage continuity and posterity, securing relationships and pressure from relatives to reproduce. Challenges included: risk of HIV transmission to partner and child, lack of negotiating power for safer sex, failure of health systems to offer safe methods of reproduction
  
  
  CONCLUSIONS
  HIV sero-discordant couples with strong desire for childbearing have a dilemma of risking HIV infection or infecting their spouse. Some risk transmission of HIV infection to reproduce. We need to address gender issues, risky behaviour and reproductive health services for HIV sero-discordant couples.
authors.affiliation: Department of Obstetrics/Gynaecology, Makerere University, Kampala Uganda. jbeyeza@yahoo.com
authors.forename: Jolly
authors.initials: J
authors.lastname: Beyeza-Kashesya
authors.forename: Frank
authors.initials: F
authors.lastname: Kaharuza
authors.forename: Florence
authors.initials: F
authors.lastname: Mirembe
authors.forename: Stella
authors.initials: S
authors.lastname: Neema
authors.forename: Anna Mia
authors.initials: AM
authors.lastname: Ekstrom
authors.forename: Asli
authors.initials: A
authors.lastname: Kulane
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D012098:Reproduction; D012309:Risk-Taking; D021841:Safe Sex; D012747:Sexual Partners / Q000523:psychology*; D012959:Socioeconomic Factors; D014342:Truth Disclosure; D014454:Uganda; D055815:Young Adult