HIV positive and wanting to be a mum: a risky part of the Ugandan woman’s culture

Prevention of mother to child transmission initiatives mean women living with HIV means a woman’s urge to have children can be fulfilled but issues of disclosure and family planning guidance remain a challenge – as does the risk of infection in discordant couples who desire to have children, reports KC Owamazima.

In most African cultures, as is realized in Uganda, having children is not an option but a privilege fiercely supported by tradition. It is known among various tribes in the country such as the Banyankole, Batooro and Baganda that a woman remains a girl unless she fulfils the birth ritual.

In some cultures if a woman does not meet the motherhood criteria by not giving birth she is castigated even as she is being buried. This brings to mind the tight spot an HIV positive woman is placed in when she upholds cultural values as well as the innate motherly desires to have a child and yet has to embrace the health reports on dangers of pregnancy to both her and the child she is to conceive.

Amooti, a mother of two who is living with HIV in Kabarole District, says she desired to have a son and since her two daughters were HIV negative she saw nothing wrong with meeting her heart’s desire. But Amooti’s positive status meant she had to consider the danger of transmitting the virus to her partner. She also had to consider the risk of transmitting HIV to her unborn child, a situation that can now be presented given the correct adherence to a preventing mother to child (PMTCT) transmission programme.

Akugizibwe Rosemary, a clinical officer in charge of ART clinic at Kagadi Hospital, says: “Of course, due to cultural [beliefs] a woman should bear children and there are disclosure issues [for HIV positive women] that often arise among couples, which cause a woman to continue conceiving [even when there is a risk of transmission].”

Rosemary says she deals with many people living with HIV who conceive without tackling the risks of transmission. She says some simply have a negative attitude towards family planning, others have HIV+ children and keep trying for children who are born HIV free, while others have no children and want to be parents.

Gilbert Tumwebaze a Clinical Officer in Mitoma District explains that PMTCT initiatives, the number of women living with HIV desiring to have children has increased.

“We have seen such cases because they want HIV- children but the problem we have is of discordant couples who want to have children. We normally advise them to use a condom but then the women want to get pregnant so we normally refer them to other health units where they can get artificial insemination done.”