Llenge those who stigmatize them and refuse to accept the dominant perspective that they are “deviant” [43]. Stigmatized people will not always suffer low esteem and many continue to perform at high levels, are happy and resilient and have a range of coping strategies [44]. Many PLHIV maintain positive attitudes, and constructively engage with their communities to reduce stigma and increase knowledge about HIV [45]. Positive activism by stigmatized people challenges stereotyping and discrimination and it can lead to improvement in the status and overall physical and psychological health of the stigmatized population [42]. Positive support from family, BX795 biological activity community and health systems can help PLHIV maintain the desire to have children. Participants who did not experience overt stigma continued to desire children and utilized health services to achieve better health outcomes for their children through adopting strategies for reducing MTCT. However, the same agents can have a negative influence on the desire to have more children through verbal abuse from health workers or neighbours or via desertion by spouses. In fact, childbearing and pregnancy among PLHIV triggered further stigmatization in the form of insults and BX795 site mocking from the community and health professionals. The combination of insults, mocking and overt hostility from community members, coupled with feelings of worthlessness and isolation from friends and family, reduced the desire to have children among some PLHIV. Other PLHIV sought new relationships with other HIVpositive people. Keeping a physical or emotional distance from “normal” (uninfected) individuals was a form of stigma management, and it also facilitated remarriage and rekindled a desire to have children among some PLHIV. What is clear in this study, however, is that PLHIV do have a good understanding of the potential to infect their children, but the social drivers that force them to have more children place them “between a rock and a hard place” because they wish to have children of their own to enhance their social standing among family, clan and tribe members. Both male and female identities are tied to their ability to have children and PLHIV may rather face the consequences of HIV transmission to their partners and children than be labelled “infertile”. Because parenthood in many African societies is the major purpose, and the primary value, of a marriage,members of those societies are not complete until they have had children of their own [19,46]. It is against this backdrop of a strongly patriarchal society, coupled with high levels of poverty and lack of social support, that PLHIV have to make difficult decisions around having children that they could potentially infect. In societies with low literacy, endemic poverty, high child mortality and lack of social welfare and security programmes, children are considered as a form of insurance to provide support in old age. Having children in Uganda increases a person’s social status [47] and this also applies to couples living with HIV. What is interesting is that the term “useless” was used twice: once when describing the inability to having children, but also when an individual has contracted HIV. So there is a stigma related to not having children, as well as a stigma associated with an HIV-positive person having children. However, it is also clear that PLHIV are not callous, deliberately having children as they please and putting them at risk of infec.Llenge those who stigmatize them and refuse to accept the dominant perspective that they are “deviant” [43]. Stigmatized people will not always suffer low esteem and many continue to perform at high levels, are happy and resilient and have a range of coping strategies [44]. Many PLHIV maintain positive attitudes, and constructively engage with their communities to reduce stigma and increase knowledge about HIV [45]. Positive activism by stigmatized people challenges stereotyping and discrimination and it can lead to improvement in the status and overall physical and psychological health of the stigmatized population [42]. Positive support from family, community and health systems can help PLHIV maintain the desire to have children. Participants who did not experience overt stigma continued to desire children and utilized health services to achieve better health outcomes for their children through adopting strategies for reducing MTCT. However, the same agents can have a negative influence on the desire to have more children through verbal abuse from health workers or neighbours or via desertion by spouses. In fact, childbearing and pregnancy among PLHIV triggered further stigmatization in the form of insults and mocking from the community and health professionals. The combination of insults, mocking and overt hostility from community members, coupled with feelings of worthlessness and isolation from friends and family, reduced the desire to have children among some PLHIV. Other PLHIV sought new relationships with other HIVpositive people. Keeping a physical or emotional distance from “normal” (uninfected) individuals was a form of stigma management, and it also facilitated remarriage and rekindled a desire to have children among some PLHIV. What is clear in this study, however, is that PLHIV do have a good understanding of the potential to infect their children, but the social drivers that force them to have more children place them “between a rock and a hard place” because they wish to have children of their own to enhance their social standing among family, clan and tribe members. Both male and female identities are tied to their ability to have children and PLHIV may rather face the consequences of HIV transmission to their partners and children than be labelled “infertile”. Because parenthood in many African societies is the major purpose, and the primary value, of a marriage,members of those societies are not complete until they have had children of their own [19,46]. It is against this backdrop of a strongly patriarchal society, coupled with high levels of poverty and lack of social support, that PLHIV have to make difficult decisions around having children that they could potentially infect. In societies with low literacy, endemic poverty, high child mortality and lack of social welfare and security programmes, children are considered as a form of insurance to provide support in old age. Having children in Uganda increases a person’s social status [47] and this also applies to couples living with HIV. What is interesting is that the term “useless” was used twice: once when describing the inability to having children, but also when an individual has contracted HIV. So there is a stigma related to not having children, as well as a stigma associated with an HIV-positive person having children. However, it is also clear that PLHIV are not callous, deliberately having children as they please and putting them at risk of infec.
