title: Reproductive decisions of couples living with HIV in Malawi: what can we learn for future policy and research studies?
abstract: BACKGROUND
  The rapid scale-up of free antiretroviral therapy has lead to decline in adult mortality at the population level and reduction of vertical transmission. Consequently, some couples living with HIV are maintaining their reproductive decisions; marrying and having children. This paper analyses policies and guidelines on HIV, AIDS and sexual and reproductive health in Malawi for content on marriage and childbearing for couples living with HIV.
  
  
  METHODS
  A qualitative study using interpretive policy analysis approach was conducted from July to December 2010 in two phases. First, data on access to HIV, AIDS and sexual and reproductive health services were collected using in-depth interviews with twenty couples purposively sampled in matrilineal Chiradzulu and patrilineal Chikhwawa communities. Secondly, data were collected from Malawi policies and guidelines on HIV, AIDS and sexual and reproductive health. The documents were reviewed for content on marriage and childbearing for couples living with HIV. Data were analysed using framework approach for applied policy analysis.
  
  
  RESULTS
  Four categories emerged from each phase. From the study, we extracted health workers attitudes, weak linkage between HIV, AIDS and sexual and reproductive health services, contradictory messages between media and the hospitals and lack of information as factors directly related to guidelines and policies. Analysis of guidelines and policies showed non-prescriptiveness on issues of HIV, AIDS and reproduction: they do not reflect the social cultural experiences of couples living with HIV. In addition, there is; lack of clinical guidelines, external influence on adoption of the policies and guidelines and weak linkages between HIV and AIDS and sexual and reproductive health services.
  
  
  CONCLUSIONS
  This synthesis along with more detailed findings which are reported in other published articles, provide a strong basis for updating the policies and development of easy-to-follow guidelines in order to effectively provide services to couples living with HIV in Malawi.
authors.affiliation: Faculty of Nursing, Kamuzu College of Nursing, University of Malawi, Blantyre Campus, P.O. Box 415, Blantyre, Malawi.
authors.forename: B
authors.initials: B
authors.lastname: Chimphamba Gombachika
authors.affiliation: Faculty of Nursing, Kamuzu College of Nursing, University of Malawi, Blantyre Campus, P.O. Box 415, Blantyre, Malawi.
authors.forename: E
authors.initials: E
authors.lastname: Chirwa
authors.affiliation: Faculty of Nursing, Kamuzu College of Nursing, University of Malawi, Lilongwe Campus, Private Bag 1, Lilongwe, Malawi.
authors.forename: A
authors.initials: A
authors.lastname: Malata
authors.affiliation: University of Oslo, Institute of Health and Society, Department of Community Medicine, Oslo, Norway, P.O. Box 1130 Blindern, 0318 Oslo. , Mobile (+47) 45 7743 70. Telefax: (+47) 22 85 05 90.
authors.forename: J
authors.initials: J
authors.lastname: Sundby
authors.affiliation: University of Oslo, Institute of Health and Society, Department of Community Medicine, Oslo, Norway, P.O. Box 1130 Blindern, 0318 Oslo. , Mobile (+47) 45 7743 70. Telefax: (+47) 22 85 05 90.
authors.forename: H
authors.initials: H
authors.lastname: Fjeld
mesh_terms: D003657:Decision Making; D005191:Family Characteristics; D005260:Female; D017408:Guidelines as Topic; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy / Q000639:trends; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008295:Malawi; D008297:Male; D011050:Policy Making; D036301:Qualitative Research; D046269:Reproductive Rights