When people hear of children born with or living with HIV/AIDS initial reactions often include that of pity. We pity these children who we label as unfortunate and sick, and often others even believe these children will never be able to live full lives, particularly as their family may believe that they will never be able to meet familial expectations of providing a son-in-law/daughter-in-law and children to add to the family. Family members and relatives of the infected child may even treat the child differently based on this assumption. Given that family is very important within the Zimbabwean context, isolating HIV positive children and adolescents as a distinct group which does not and SHOULD NOT be allowed to start families can be very damaging and lead to difficulties when it comes to forming relationships and coping with one’s status.
This paper aims to explore the desire and ability that HIV positive adolescents have, to engage in romantic relationships and start a family. It is essential for HIV positive adolescents to be included in dialogues regarding youth sexual and reproductive health so they too are able to attain and maintain the highest level of sexual and reproductive health.
The quest for love
When one is diagnosed with HIV some people assume that their hopes and dreams become unimportant or that the individual could even see no point in having them as their life span is uncertain. Research conducted in Uganda showed that in reality most HIV positive adolescents (70%) did not construct their life around their illness, instead they were more worried about ‘normal’ issues faced by adolescents including their looks and dating (Burungi, Mugisha & Nyombi, 2007). This research also showed that adolescent girls perinatally infected with HIV usually see no problem with them living a ‘normal’ life which includes getting married and having children. In fact, they begin exploring their sexuality at the same age as their HIV negative peers, and some even fall pregnant during this time (Burungi, Mugisha & Nyombi, 2007). As in the Ugandan study, my findings showed that in Harare, adolescent girls born with HIV strive to live a full life and therefore also embrace their sexuality and prospects of love, marriage and starting families. Only one participant stated that they found it difficult starting or maintaining relationships with members of the opposite sex.
Not all the participants had been romantically involved since they found out they were HIV positive. One participant was in a relationship whilst the other was single at the time but had been romantically involved in the past. Another participant had not yet had the chance to date although this is only because of a personal decision she made. When asked whether she had been romantically involved since finding out her HIV status she responded:
“there are some (boys) who have shown interest but I feel that I’m not yet at the age where I should be having a boyfriend but once I get to the age I’m sure it won’t be a problem”.
This shows that dating is something that adolescent girls living with HIV regard as normal and they don’t let their HIV status stop them from also experiencing love.
Another participant said:
“I can say that this issue on marriage is possible. Yes I can get married but it’s really difficult to find a man who really loves you and at the same time you’ll be fearing that you may get disappointed with this guy….”
This response shows the fear that any adolescent girl would have about not being able to find true love or things going wrong with a loved one. Overall, 80% of the participants stated that they did want to get married and have children. This supports Chen et al’s research results that concluded that many HIV positive individuals did indeed intend to start a family (2001). When I asked about her views on marriage and starting a family the participant failed to respond and became emotional, leading to the interview being cut short. Her grandmother however responded on her behalf and said “she knows that’s not a possibility for her because of her illness”..
This response reflects the attitude that some parts of society may have towards the idea of marriage being a possibility for people with HIV. It is seen as something that will not, and should not happen. Some adolescents living with HIV may actually live in fear of transmission and may therefore feel the need to refrain from sexual activity. This fear may be reinforced by parents and care givers who put pressure on them to abstain from sex, and even put off having children when they are older as this is seen as unfair to the child who may be born HIV positive or may be negative but soon be left as an orphan (Close, 2009). There is therefore sometimes an internal battle between what the individual feels and what primary reference groups expect of them. This pressure is something that may be avoided by educating not only HIV positive adolescents but their families and communities regarding the medical breakthroughs that make it possible for HIV positive individuals to live healthy lives and start healthy families. Addressing these issues may be able to decrease stress levels and help ensure that HIV positive adolescents have good mental and emotional health alongside their physical health.
HIV, Medical breakthroughs and the prospect of starting a family
Due to the use of ART, having an HIV negative child has become possible for women who carry the virus. In the developing world, if an HIV positive woman is well cared for and given all the necessary drugs during her pregnancy and during childbirth, the chance of her child being born with the virus can be reduced to below 2% (Tang & Nour, 2010). Along with this is the added advantage of procedures such as sperm washing that not only allow for an HIV negative woman to have a child with her positive partner without engaging in unsafe sex but for two HIV positive partners to increase the chances of having an HIV negative child whilst ensuring they avoid the chance of reinfection through unprotected sex (Chen et al., 2001). Sperm washing occurs when the sperm cells are separated from seminal fluid, which is said to be the HIV carrier and not the sperm itself. This is therefore the safest way for an HIV positive man to biologically father a child as it reduces the risk of the infection being passed on to the unborn child and in cases of a mixed status couple, to the mother as well (National Aids Manual, 2013).
Nowadays it is possible to find “mixed-status” couples where only one of the partners is HIV positive. Although this is the case these couples may face many challenges and in many cases the relationship does not last long as the infected partner may continuously worry about endangering the other person while the uninfected partner constantly worries about getting a life-threatening illness (aidsinfonet, 2013). Amongst my participants, discussions of marriage were initially based on the idea of them marrying an HIV positive man as this decreases the fear of infecting their partner. This gives the impression that HIV positive adolescents may view unprotected sex with an HIV positive partner as an acceptable practice. This highlights the importance for adolescents to be educated about the possibility of re-infection and increasing their viral load by engaging in unprotected sex with an HIV positive partner.
The chance of ending up with a partner who is HIV negative is also a possibility that I picked up on during data collection. One of the participants who had actually been in a relationship with an HIV negative boy who knew her status noted that she was fine being in such a relationship as long as the partner was understanding and did not fear being infected. However, her aunt discouraged her from continuing with the relationship and she herself eventually decided to end things as there were many complications that arouse because of the mixed status, the main one being her fear of transmitting the virus to him and thus being responsible for “ending” his life.
The general idea amongst the participants was that as long as the HIV negative boy was willing to accept their HIV status then having a relationship with him would not be strenuous. However, from the experience mentioned above it is evident that the situation may be a lot more complicated than expected. The pressure from family members and the fear of being responsible for infecting another person may be too great for some individuals to handle. Although the participants also stated that they did sometimes think about the possibility of infecting a partner or giving birth to an HIV positive child there was a general consensus that these fears would not stop them from going ahead with their plans to get married and start a family of their own. This shows that to some extent, whether or not society approves of HIV positive individuals engaging in sexual activities, this is a part of reality that particularly needs to be addressed amongst infected adolescents.
HIV positive adolescents are likely to approach romantic relationships and the idea of starting families the same way if their peers do so negatively. Emphasis should therefore be placed on involving them in initiatives surrounding youth sexual and reproductive health and rights. Secondly, communities should also be educated to decrease the negative attitudes surrounding HIV positive individuals’ sexuality. Friends and family are an important starting point for addressing these issues to encourage the formation of healthy relationships and supports the adolescent’s desire to form and maintain romantic relationships. It is also our duty as society to stop boxing in HIV positive individuals, especially young people who were infected from birth and also long for the chance to live a full life.
AIDS Infonet, 2013. Couples With Mixed HIV Status. [Online]
Available at: http://www.aidsinfonet.org/fact_sheets/view/613
[Accessed 07 04 2013].
Birungi, H., Mugisha, J. & Nyongi, J., 2007. Sexuality of young people perinatally infected with HIV: A neglected element in HIV/AIDS planing in Uganda, s.l.: The AIDS Support Organization.
Chen, J. et al., 2001. Fertility Desires and Intentions of HIV-Positive Men and Women. Family Planning Perspectives, 33(4), pp. 144-152.
Close, K., 2009. Psychosocial Aspects of HIV/AIDS: Children and Adolescents. HIV Curriculum for the Health Professional.
National Aids Manual, 2013. Sperm Washing. [Online]
Available at: http://www.aidsmap.com/pdf/Sperm-washing/page/1044934/
[Accessed 04 09 2013].
Tang, J. & N, N., 2010. HIV and Pregnancy in Resource-Poor Settings. Obstetrics & Gynecology, 3(2).