Marriage and fertility among HIV+ people in Nigeria

Daniel Smith, Brown University
Benjamin Mbakwem, Community and Youth Development Initiatives (CYDI)

This paper examines the marital and fertility aspirations and behaviors of HIV-positive people who are enrolled in antiretroviral therapy in Nigeria. It evaluates the effects of these aspirations and behaviors on sexual behavior, disclosure, and adherence. Interviews and observations of people on treatment demonstrate that marriage and childbearing are paramount desires for people whose health is restored by antiretroviral therapy. The concept of life projects is introduced and combined with the established idea of therapeutic itineraries to show how participation in and adherence to treatment, disclosure of HIV status, and decisions about sexual behavior cannot be understood in purely medical terms. Marital and reproductive aspirations routinely impinge on and often trump clinical and public health priorities. Emblematic case studies are briefly narrated to illustrate the social dynamics that motivate and explain behavior seemingly inimical to individual and public health.