HIV and contraception

It was the 5th pregnancy for a HIV positive lady. When the tests confirmed pregnancy, she was devastated. What can I do now? This was her question. Her husband also being HIV positive, she knows very well that unless she takes preventive therapy for the unborn baby, the baby will get infected. Bringing up another baby in available resources is yet another problem. Moreover the couple knows that if not very careful they may become sick with opportunistic infections or side effects of drugs or worse still may die, leaving behind orphans. Knowing these risks fully well, the couple was careless and hence this unwanted pregnancy. Abortion is illegal and has many health hazards, hence not the solution for an undesirable pregnancy. Every HIV affected adult is counseled about use of condoms during their visit to the hospital/ HIV clinics for whatever purpose. They are explained about the risk of transmitting and acquiring S.T.Ds (sexually transmitted diseases), without a condom and also pregnancy. The counselors working here in HIV/AIDS clinics explain all this very well. In this scenario it is important that couples, particularly men take the issue of using condoms seriously. Because mostly it is the men who are reluctant to adopt contraceptive measures. They being the decision makers in the family, women are left with no choice. There are many reasons why people hesitate to use contraception. Religion, being one of the reasons! The Pope has commented recently, that use of condoms is acceptable in certain situations to prevent HIV/AIDS. Thus if the highest authority of the Church has recommended use of condoms, nobody should have any hesitation to use them. Reduced, “masculinity”, is another myth which prevents use of condoms. But men have to be counseled that condoms in no way reduce the sexual prowess of a man. Condoms are useful in preventing unwanted pregnancies and also HIV/AIDS and other sexually transmitted diseases and are efficient in more than 80% of cases. At times one may have failure with condom use also, but that is rare. It happens more where poor quality condoms are used or if not used correctly. But good quality latex condoms rarely break. Condoms should be discarded after use; otherwise there is risk of infection and condom failure. Female condoms came into existence in 1993. Since 2005, they have been promoted for prevention of HIV/AIDS in countries like South Africa, Zimbabwe where there is a high prevalence of HIV. Though female condoms are equally useful in prevention of HIV and sexually transmitted diseases, but they are not as easy to use as a male condom. They are not available readily and are more expensive. One should be cautious to see that both partners should not use condom at the same time as the friction can cause the condom to rupture. In some cases, the couples are least bothered about family planning methods. For them any child coming is a blessing from God and also a helping hand in their work. They do not bother about lack of adequate resources in the family and say that if God has given the baby, he will provide. This theory is fine, with one part missing which they do not consider. God has also given prudence to make their own decisions in life and quality of life depends on good or bad decisions taken. Best course for a seropositive couple after they have completed their family would be to get sterilization (vasectomy or tubectomy) done. This way, they would be totally carefree about future unwanted pregnancies. But this should be done only after their youngest child is at least 5 years or more to cover the risk for a child dying due to childhood infections. Since this is an extreme step, there should be consent of both partners otherwise it can become a source of marital conflict. Family planning, i.e. a small family with planned number of children and proper adequate spacing between each child is beneficial for all couples, more so for couples who are HIV positive or where one of the partners is HIV positive. By planning their family, they can make best use of available resources and ensure good health for themselves and their children. rachna212002@yahoo.co.uk