Antiretroviral therapy, perceived health, and fertility decision-making among people living with HIV: a qualitative study at a district antiretroviral therapy clinic in the Ashanti Region, Ghana.

Abstract

Antiretroviral therapy has changed what parenthood can mean for people living with HIV, yet little is known about how patients at district-level clinics in West Africa themselves connect treatment, bodily health, and decisions about childbearing. This study explored how people living with HIV attending one district antiretroviral therapy clinic in Ghana's Ashanti Region described the place of treatment in their reproductive thinking. A qualitative interview study analysed using reflexive thematic analysis informed by an interpretive phenomenological orientation. Twelve adults receiving antiretroviral therapy at the St. Michael's Hospital clinic in Pramso took part in semi-structured interviews conducted in English or Twi between August and October 2024. Interviews were audio-recorded, transcribed, and coded inductively, with the Theory of Planned Behaviour applied interpretively after coding. Four participants described treatment access and clinic services as adequate. Within these accounts, one participant linked daily medication-taking to a felt state of bodily wellness, and one reported believing that medication would not harm a baby; no participant explicitly connected bodily wellness to a decision about childbearing. Transmission concern was more widely expressed, and several participants relayed provider messages that a baby could be protected, with one woman also reporting having been told how to conceive without infecting her partner. Fertility positions were heterogeneous: some deferred decisions, some limited further births after completing their families, one woman described pressure from her husband to have another child, and the one man whose account addressed this topic framed his position economically rather than around transmission. Emotional uncertainty persisted alongside accurate prevention information. No participant referred to viral load results, undetectable status, or viral load monitoring, and the interview guide did not ask about these. Reproductive positions at this clinic were shaped by parity, partnership, economic circumstance, and emotion, with HIV status carrying variable weight. The data show that treatment access was valued but do not establish that perceived health drove reproductive intentions, and because viral suppression was neither verified nor discussed, claims that suppression shapes fertility decisions are not supported. Findings are specific to this setting and indicate scope for counselling that pairs biomedical information with emotional and individualised support.