Women Living with HIV: Social Stigma and Reproductive Decisions

Since HIV was first diagnosed, the pandemic has changed substantially in terms of both life expectancy and quality of life. One of the most significant has been the substantial reduction in mother-to-child transmission of the disease. Evidence from around the world shows that many HIV-positive women continue do want children, but that they may experience stigmatization regarding their decision, ostensibly out of concern for the child. Much of the field's understanding of HIV-related stigma revolves around the idea that it is predominantly a disease of sexual promiscuity and drug use. However, many people living with the disease are also marginalized based on other factors, such as race, poverty, homelessness, and gender, thus making stigma a profoundly more complicated issue, and blurring our ability to specify the causes of stigmatization that a person may experience. Thus the overarching goal of this dissertation was to examine factors that may influence reproductive decisions for HIV-positive women. In particular, what is the role of social stigma for these women, and how do their social situations affect their decisions? In order to examine different aspects of these questions, three research studies were conducted: a secondary analysis of quantitative data from pregnant women in Kenya with unknown HIV status; a quantitative study of social capital and stigma in HIV-positive women in the San Francisco Bay Area; and a qualitative study of childbearing decision-making in HIV-positive women in the San Francisco Bay Area. The results of all three studies demonstrate how HIV-related stigmatization affects women's lives, and trace the ways that cultural meanings, power inequalities, and creation of difference lead to stigmatization. Women living with HIV continue to want to bear children for many reasons, but all are aware of negative public opinions about this. The provision of health care in specialized environments may be one way to mitigate the effects of stigmatization and provide social support. However, structural changes such as empowerment of women are needed to truly address the stigmatization that women experience related to their HIV