Exploring incident HIV in pregnant women and wexual risk behaviours and practices in Soweto, South Africa

HIV infection is an important risk for maternal and neonatal morbidity and mortality, which can, however, be mitigated by timely initiation of antiretroviral therapy (ART). Prevention of Mother to Child Transmission (PTMCT) and Anti Retroviral Therapy (ART) coverage have increased in the last few years, leading to a decrease in maternal mortality in some countries within sub-Saharan Africa, and to a decrease in new infections. Still, many women in need of medication do not access ART. In addition to failure to access ART, there may be other continued risks of HIV infection during pregnancy, particularly in low resource settings, for behavioural and biological reasons. In sub-Saharan Africa, the high prevalence of HIV infection among pregnant women makes the interaction between HIV and other maternal morbidities an important public health issue. The epidemic has found a wealth of opportunities to thrive in the context of constrained and tragic human conditions, fuelled by poverty, abuse, violence, prejudice and ignorance.
This PhD thesis employs a life history approach and gives more insight on sexual risk behaviours and practices of both men and women during pregnancy in urban South Africa. Sexuality is lived and practiced within the context of local sexual cultures. Different cultures and traditions influence behaviour in particular ways, whether or not it is considered acceptable by local norms and traditions. In the context of HIV diagnosis,there is further complications as women try to deal with the new HIV infection, and questions of disclosure, support, intimacy, trust, violence and negotiating safer sex spaces for themselves and their partners. The challenges that exist for both women and men in securing and maintaining long-term relationships, and their fear of loss of current partners, complicate their efforts to address issues of HIV risk and sex in pregnancy. This thesis accentuates the need for policy reforms in South Africa and similar contexts to address the importance of sexual risk behaviours and practices, and to provide support in pregnancy to manage the emotional and personal difficulties during and post pregnancy.