Fertility intentions among people living with HIV and AIDS (PLWHA) are fraught with ambivalence: Mixed methods evidence from Nairobi slums.

Fertility intentions are strong predictors of eventual fertility, yet little is known about the fertility desires of HIV-infected persons in sub-Saharan Africa. Given the recent and rapid expansion of access to antiretroviral therapy (ART), understanding the fertility intentions, and consequent reproductive health services needs, of men and women living with HIV/AIDS is critical. Emerging evidence on the effect of HIV/AIDS/ART on fertility intentions is mixed with little or no explicit theoretical understanding. This study investigates fertility intentions of PLWHA using mixed methods population-based data collected 2010-11, comprising survey (n=513) and in-depth (n=41) qualitative interviews of PLWHA in Nairobi slums. We show that fertility intentions of PLWHA are fraught with ambivalence and ambiguity due to conflicts between social pressures for biological parenthood and moral pressures to avoid co-infection and future child orphanhood. The implications for reproductive health service provision are explored using in-depth interviews (n=14) with service providers.