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. 2025 May;29(5):1414-1427.
doi: 10.1007/s10461-025-04611-3. Epub 2025 Jan 17.

"You're in an Image of a Man but Not a Man": A Qualitative Analysis of Intersectional Stigma Among Men with HIV Experiencing Subfertility in Rural Southwestern Uganda

Madeline C Pratt  1 , Moran M Owembabazi  2 , Alex T Menninger  3 , Eunice Kanini  2 , B Rosemary Kansiime  2 , Patricia M Smith  4 , Janet M Turan  5 , Lynn T Matthews  4 , Esther C Atukunda  2
Affiliations

"You're in an Image of a Man but Not a Man": A Qualitative Analysis of Intersectional Stigma Among Men with HIV Experiencing Subfertility in Rural Southwestern Uganda

Madeline C Pratt et al. AIDS Behav. 2025 May.

Abstract
in English, Spanish

Many men with HIV (MWH) want to have children and may encounter HIV- and infertility-related stigma experiences. Integration of reproductive health and HIV care for men is rare. When available, safer conception care focuses on HIV prevention but lacks fertility support. We conducted qualitative in-depth interviews in Uganda with 30 MWH who desired more children and self-reported no partner pregnancy after 12 or more months of conception attempts. We separately interviewed 10 female partners. Interviews explored stigma experiences and factors impacting engagement in HIV and reproductive care. We used vignettes to elicit responses to stories of couples experiencing challenges of HIV and subfertility. The study team discussed, coded, and analyzed data from individual participant interview transcripts, inductively identifying emergent themes. The following overarching themes emerged: (1) Reproductive goals often take priority over HIV prevention among HIV-affected couples in this context, influenced by multi-level subfertility stigma in society. (2) MWH may pursue behaviors that increase risk of HIV transmission to meet their reproductive goals. (3) Men and women are eager to maintain their primary partnerships, prevent HIV transmission, and meet their reproductive goals with guidance from healthcare providers. Further research is needed on the causes of subfertility and infertility among HIV-affected couples in East Africa to better support their conception goals. Additionally, studies on the intersection of HIV and infertility stigma in high-fertility, high-HIV prevalence areas are essential for designing interventions that meet couples' social, emotional, and medical needs.

Muchos hombres con VIH desean tener hijos, pero enfrentan el estigma relacionado con el VIH y la infertilidad. La integración del VIH y la atención reproductiva para los hombres es poco común. Realizamos entrevistas en profundidad con 30 hombres con VIH en Uganda que deseaban tener más hijos, pero no habían logrado el embarazo después de 12 meses o más de intentarlo, y entrevistamos por separado a 10 parejas femeninas. Las entrevistas exploraron el estigma y los factores que afectan la participación en el VIH y la atención reproductiva. Surgieron tres temas principales: (1) Los objetivos reproductivos a menudo tienen prioridad sobre la prevención del VIH, influenciados por el estigma social en torno a la subfertilidad. (2) Los hombres con VIH pueden participar en conductas que aumentan el riesgo de transmisión del VIH para alcanzar los objetivos reproductivos. (3) Tanto los hombres como las mujeres desean mantener relaciones, prevenir la transmisión del VIH y alcanzar los objetivos reproductivos con apoyo de atención médica. Se necesita más investigación sobre las causas de la subfertilidad y la intersección del estigma del VIH y la infertilidad en áreas con alto índice de VIH para mejorar las intervenciones para las necesidades sociales, emocionales y médicas de las parejas.

Keywords: Fertility; HIV; Qualitative methods; Safer conception; Stigma; Uganda.

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Conflict of interest statement

Declarations. Competing Interests: The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Fictional vignettes were used to frame questions about couples and scenarios dealing with issues related to HIV and sub-fertility
Fig. 2
Fig. 2
Number of men who were screened, eligible, and enrolled in the qualitative study aim
See this image and copyright information in PMC

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References

    1. Yan X, Du J, Ji G. Prevalence and factors associated with fertility desire among people living with HIV: a systematic review and meta-analysis. PLoS ONE. 2021;16(3):e0248872. - PMC - PubMed
    1. Pratt MC et al. ‘I still desire to have a child’: a qualitative analysis of intersectional HIV- and childlessness-related stigma in rural southwestern Uganda. Cult Health Sex. 2022:1–16. - PMC - PubMed
    1. Atukunda EC, et al. A qualitative exploration to understand barriers and facilitators to daily oral PrEP uptake and sustained adherence among HIV-negative women planning for or with pregnancy in rural Southwestern Uganda. J Int AIDS Soc. 2022;25(3):e25894. - PMC - PubMed
    1. Kaida A, et al. High incidence of intended Partner pregnancy among men living with HIV in Rural Uganda: implications for Safer Conception services. J Acquir Immune Defic Syndr. 2019;81(5):497–507. - PMC - PubMed
    1. Matthews LT, et al. Consensus statement: supporting Safer conception and pregnancy for men and women living with and affected by HIV. AIDS Behav. 2018;22(6):1713–24. - PMC - PubMed

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