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Sex and fertility versus health in AIDS stricken Africa

How do you reconcile the basic sexual and fertility needs of 25 million Africans with the stark reality of HIV/AIDS?


Roughly 25 million people are living with HIV/AIDS in Sub-Saharan Africa. That’s about half of the total population of England, to put it into perspective.

The impact is devastating and extends way beyond a health crisis, with far reaching effects on the African workforce, family, education system and the economy in general.

At a micro level, how do individuals in Africa deal with the diagnosis and the reality of living with HIV/AIDS?

LSE demographer Dr Ernestina Coast, an Associate Professor of Population Studies, has been researching this topic with funding from the Wellcome Trust|.

By focusing on a small section of the population – HIV/AIDS adults living in the Nairobi slums – Dr Coast and her colleague Dr Eliud Wekesa have identified the major issues that people living with HIV/AIDS and health workers are dealing with in the region.

The vast numbers of people infected with HIV/AIDS is the first hurdle. In Kenya alone, 1.6 million people live with the condition and while the introduction of antiretroviral therapy (ART) has improved their prognosis, there are many other factors impeding progress.

Societal pressures to have children often outweigh the concerns that people have with re-infection, Dr Coast says.

“More than one third of men and women living with HIV/AIDS still want children, despite the risks. This desire is driven by a range of things, including status, social support and household wealth.

“Children are bearers of the family name, they look after parents in old age and they also provide security and status, especially for women,” Dr Coast says.

In Kenya, more women than men are infected with HIV/AIDS and while two thirds of them wish to stop childbearing, their contraceptive needs are often ignored by over-stretched health workers. The latter tend to focus on counselling, HIV testing and ART services.

Only 56% of Nairobi slum dwellers with HIV/AIDS use condoms, despite their multiple benefits: preventing unwanted pregnancies, reducing infant and maternal deaths, and stopping transmission of HIV.

People diagnosed with the disease react in different ways. A diagnosis can involve both distress and denial, with many women unwilling to disclose their status for fear of being linked with prostitution, despite the fact they are monogamous.

Prayer and religion also play a major role, as infected people turn to their faith, believing it might cure the disease.

Others fail to take the prescribed drugs, not only because of their side effects, but also because they require patients to be well nourished during the course of treatment. Many don’t have the means to buy food in the first place so it defeats the purpose.

“Most people infected with HIV/AIDS are likely to under report their sexual activity and men are particularly resistant to using condoms,” Dr Coast says.

“A tension exists between the high value placed on parenthood in Africa and the potential health risks of spreading HIV/AIDS. We have to find a way to support the conflicting desires of childbearing and the need to halt the transmission of AIDS.”

Effective family planning is the first step. Ensuring couples are counselled on the ovulation cycle to make conception more likely while limiting unprotected sex is vital, Dr Coast says.

Contraceptive use must be a priority and family planning services need to be made an integral part of services for HIV/AIDS patients.

“There is growing recognition that we need to support the rights of HIV/AIDS-infected people in sub-Saharan Africa to be sexually active because to deny them this basic human need causes distress, depression and anxiety,” she adds.

Additional notes

Dr Ernestina Coast is an Associate Professor of Population Studies in the Department of Social Policy at LSE. Dr Eliud Wekesa was a PhD student at the LSE. The two have written a set of articles on HIV/AIDS in Africa as part of a Wellcome Trust-funded project at LSE.

Their latest paper| on fertility desires among men and women living with HIV/AIDS in Nairobi slums

More details of Dr Coast’s work can be found on her website|.

Posted 1 October 2014