Electronic supplementary material
Study participants and recruitment
33 [28, 35]
Time on ART (years)
Number of live births
4 [2, 6]
Number of living children
3 [2, 4]
Months between pregnancy outcome and interview
15 [7, 21]
Most recent CD4 cell count (cells/mm3)
Challenges and coping
In my life, I was feeling I hated myself; I was suspicious that everybody knew my HIV status. I felt I was finished, I did not want to see people, and I spent much of the time in the house. Whenever I would see someone, I would think that this one knows things about me, I was always quiet and alone. I would not be outside, unless when I was going to hospital. - (Participant #8, 5 months postpartum).
I denied myself, but later I consoled myself and I felt I would go through this. I consoled myself as a person and said that let me not become a laughing stock, good enough am not the first one and am not the last one [to have HIV] . It is a usual thing; let me accept. - (Participant #8).
Before I started ARVs, I was not well, physically, and my CD4s were low. I would feel rejected among my friends. However when I started ARVs I felt strong, and I said ‘why don’t I have a baby?’ I had good health, I came to like myself, I cooked food, I ate it, and I was happy. I was not thinking that HIV is even there. I accepted myself. I felt like HIV was like any other illness like malaria or just a minor accident you can get while taking a walk. I felt that strong. - (participant #6 8 months postpartum).
There is no good relationship with my partner because he has a second wife. When he saw that the children were dying, he said …let me bring another wife, the children you will have could also die. Therefore, he brought another wife and she has two children… This time when I told him that I was pregnant, he did not mind at first but when I was 8 months, he said, it is not mine; you know where you will put it [the baby]. I said, ok no problem; I will cater for myself….I felt my heart telling me, after all, I know how to work for myself, I must look for how to survive, look for money to make sure that after delivery I get food to eat. I ran up and down, did day labor , got money, kept it, bought my things for carrying the baby, I prepared myself and packed until I got into labor and came to hospital.- (Participant #11, 12 months postpartum)
When I told him [about the pregnancy], he [partner] quarrelled, and he kept quarrelling, but later … he was like of course you know how you are [HIV+]; you would stop there [having children]. You do it again [get pregnant] you will be damaging your life. Don’t think that [I] am stopping you from having children but you should know what you are. Now when I saw that he was going to stress me (… they keep, teaching us here [clinic] that when you stress yourself you lose CD4 and you will be reducing on your life), I gave up on him as a person. I knew I would not be stranded like failing to get what to put on, what to eat or what to clothe the baby; I was not scared about those because I knew I would find them. Whether the job is there or not, can a person insist and remain on one thing forever? If I lost the job, I would look for something else to do. I have my two hands.-(Participant #5, 5 months postpartum)
He (partner) was not OK [with the pregnancy] initially, though he wanted to have a child, he was also scared like me, and he was even scared more. … in the end he decided that we should not abort the baby… He promised that he would be helping me, reminding me, go to the clinic and take my medications, to make sure that I follow all these steps and see what will come out. He did more than me (laughs) because even bringing the child to the clinic, he is the one who decided and kept on monitoring, is he taking medicine, are you taking him to the clinic, can I have a look at the papers, he was more serious than I was. - (Participant #4 woman, 6 months postpartum).
When I gave birth, they [community members] helped me a lot, people gave me food, and I did not suffer at all. Even the 20,000 [Ugandan shillings] I had kept, I bought clothes for the baby. Now am fine, I have no problem. I get support from people, some give me clothes, such things, when am stuck with no school fees and transport to hospital, they help me with the money and I pay them later …. I do not get stressed; I befriended those who love me. Those who help me are also sick [HIV+], so we know each other in such problems. In addition, my sister and my brother also help me. (Participant #12 woman, 9 months postpartum)
I first felt bad and asked why I was going to give birth to those to leave behind [after death]. However, I have a friend I talked to; she has been on medicine [ARVs] for long. She told me, “You want to tell me that all these people you see…You can even produce 8 children, when you are still alive, the children will grow and get married when you are there [alive]. Don’t lose hope” that is how I gave up on thoughts and worries. - (Participant #15, 20 months postpartum).
After realizing that my second child was the way I am [HIV-positive], I felt that I should try to have another child. … I was scared but at the same time, I wanted to have one [HIV-negative child]. … I wanted a child, so I decided to accept and follow whatever the health care providers told me and make sure I get a child who is free [HIV negative]. Therefore, I decided not to stress myself … You know after accepting, there was nothing much, because I made sure I took my medicine, came for antenatal care, and things were normal. - (Participant #4 woman, 6 months postpartum).
I got so many problems… Because they tested me and found that I was HIV positive, I asked myself, ‘will I deliver the baby and it survives or am I going to suffer with this pregnancy or die?’ However, when I kept getting UARTO staff [HIV clinic] comforting me and telling me to take my medicine properly I got hope. Whenever I would go to hospital and see other women with their children who are healthy [HIV negative] yet they are on medication, I became strong. I stopped thinking and worrying, I was as if I had no virus, I ate and drank and I became strong. - (Participant #20, 18 months postpartum.
I was thinking a lot, I would think about this pregnancy, “Oh my God why did I do it, [get pregnant]” and then I would curse the man. I woke up one morning I went to throw myself in the river, [but] when I saw how the water was moving, I walked back home. I was thinking, the man had left me, I did not have money, I am HIV positive and I did not have anyone to turn to. Later I said, “Let me be patient, God will take care of me”. So whenever I would feel bothered, I would pray and I said let me hand myself to God. It helped me, because if I had not become born again [religion], I would have killed the baby and myself. However, whenever I would go to church, and I see how they pray and preach I would feel touched. I saw myself getting better and I saw that God could work. - (Participant #8, 5 months postpartum)
Before I got pregnant, we had no problem at all. However, after giving birth, he behaved extremely badly towards me. …He disturbed me a lot to the point that he no longer wanted me to work. He refused to provide support for the child and wanted to take her [child] to the other wife. He [partner] gave me many troubles. I would say that this man has killed me [infected her with HIV] and now he is making me suffer. I prayed the rosary and dedicated myself to the Virgin Mary to help me through these troubles and God helped me through. I would ask people in the village to pray for me so that my child is not taken away from me. I offered all that to God, he helped me through, in the end I was allowed to stay with my child. - (Participant #19, 21 months postpartum).