‘The old-fashioned way’: conception and sex in serodiscordant relationships after ART

Abstract

This paper explores heterosexual women's accounts of conception and sex within serodiscordant relationships in the period after the advent of Anti-Retroviral Treatment in Australia. It utilises Goffman's theory of stigma and narrative identity theory as a framework for analysis. Six women had planned and conceived pregnancies, four had an unexpected pregnancy and one was attempting to conceive. Accounts of conception usually consisted of a story that involved unprotected sex, once, for the purpose of conceiving. This included what they perceived to be an acceptable risk; one they were willing to take for the desired outcome. Two women gave accounts of artificial insemination. The conception story was usually constructed for the benefit of family and friends aware of the women's status thereby reinforcing the woman's identity as responsible and moral. However, most women revealed their partner did not like condoms and used them sporadically or not at all, directly contradicting the 'conception story'. To justify their actions as informed and responsible, women constructed accounts around low viral load and female-to-male transmission. But a consequence of limited or no condom use was that some women reported worrying about ensuing stigma from their partner's and their families if their partner did seroconvert.

Treatment-Related Optimistic Beliefs and Risk of HIV Transmission: A Review of Recent Findings (2009-2012) in an Era of Treatment as Prevention

“…There are three qualitative studies [26–28] which provided implications on how treatment-related optimistic beliefs may be connected with sexual behaviors. All three studies focused on sexual risks in HIV sero-discordant relationships.…”

“…One of the qualitative studies was related to the experience of conception with an HIV negative partner among HIV positive women [26]. It was found that these HIV positive women usually justified their unprotected sex, a behavior considered as being careless and irresponsible, by constructing accounts around minimum risk of women-to-men transmission, and the reduced infectivity due to undetectable viral load.…”

“…In the study of women’s conception experience, social discrimination, and self-imposed stigma of HIV infection appeared to have triggered participants’ desire to deny the influence of HIV on their lives through the action of normalizing sexual behaviors such as non-condom use or natural conception [26]. These actions were often supported by their HIV negativemale sexual partner who disliked condomuse.…”

Marital sex among people living with HIV receiving antiretroviral treatment in Northern Thailand

“…Before the advent of effective forms of HIV antiretroviral treatment (ART), the sexuality of people living with HIV was often viewed in terms of risk behaviour (Kalichman 2000) and the prevention of HIV transmission through adherence to safer-sex practices (Skurnick et al 1998;McDonald 2001;Bova and Durante 2003;Gacoin 2010) and/or disclosure to partners (Desgrées-du-Loû 2005). In the context of the limited lifespan of HIV-infected people at that time, very few studies examined sexual function and relationships among HIV-positive people (Meyer-Bahlburg et al 1993;Hankins et al 1997;Zierler et al 1999), implying that this was considered a subsidiary concern.…”

Perspectives on safer conception practices and preconception counseling among women living with HIV

“…Among women living with HIV, additional factors may influence reproductive decision-making, including current health status, partner HIV status, HIV disclosure, HIV knowledge, financial limitations, health care providers and health care access (Delvaux & Nöstlinger, 2007). Women’s knowledge of safer conception practices appears limited and discussions about pregnancy desires and safer conception methods with providers are rare and seldom comprehensive (South Africa: Matthews et al, 2013; USA: Finocchario-Kessler et al, 2012; Loufty, 2013; McDonald, 2011; Rahangdale et al, 2014; Steiner et al, 2013; Sutton et al 2014; Squires, 2011). In order to understand how pregnancy among HIV-infected women can be safer for women, partners and neonates, it is necessary to understand how women consider, articulate and pursue their desires to have children.…”