Choosing between Two Stigmas: The Complexities of Childbearing in the Face of HIV Infection in Sub-Saharan Africa

Laura Nyblade, International Center for Research on Women
Jessie Mbwambo, Muhimbili University College of Health Sciences
Sanyukta Mathur, International Center for Research on Women
Kerry MacQuarrie, International Center for Research on Women
Gad Kilonzo, Muhimbili University College of Health Sciences
Peter Kopoka, Muhimbili University College of Health Sciences

This paper examines how HIV-related stigma couples with strong social pressures for childbearing to constrain a woman's decisions about family planning, prevention of mother-to-child transmission of HIV (MTCT), and other HIV prevention behavior. It demonstrates how HIV-related stigma is layered onto existing stigmas women face because of their relative lack of social and economic power. Understanding how HIV infection and its accompanying stigma shape the context, needs, and desires of women, men, and their communities around childbearing is critical to providing effective family planning and MTCT prevention services. The analysis uses ethnographic data from two sources - a community-based survey on the prevention of MTCT in Botswana and Zambia and an on-going study of HIV/AIDS related stigma and discrimination in Tanzania.