Reviewer's report
Title:"I will not let my HIV status stand in the way." Decisions on motherhood
among women on ART in a slum in Kenya- a qualitative study.
Version: 1Date:22 January 2010
Reviewer: William Ledger
Reviewer's report:
This paper presents a fascinating exploration of the conundrum of HIV-positive
women in Kenya being driven to desire early motherhood before they have
reached optimal response to anti-retroviral therapy. The paper is a qualitative
study looking into the behaviour of women in a slum area of Nairobi. The
background is well described, ART treatment being provided by a
non-governmental charity.
I would recommend that the authors do not use the abbreviation “ART” since the
initials also describe assisted reproductive technology, a commonly used
acronym for IVF treatment and this may confuse readers of the paper, who may
well come from a reproductive medicine background. It may be better to use the
words “anti-retroviral therapy” in full throughout the paper. There are a few
typographical and spelling errors in the paper which require correction (e.g. page
5, line 3: “put” not “out”.
The authors used qualitative techniques with semi-structured interviews in local
language to allow women who were pregnant, postpartum or wishing to be
pregnant to describe their attitudes towards pregnancy, HIV status and
treatment. The methodologies used are well described and appropriate for a
small qualitative study. The findings illustrate the difficulty of providing retroviral
treatment to women wishing pregnancy in Kenya, and can be extrapolated to
similar communities elsewhere in the world. The great importance of motherhood
is highlighted as a driver to seeking pregnancy notwithstanding incomplete
response to anti-retroviral therapy. A number of verbatim extracts from interviews
are included – these are appropriate and illustrative. Sadly, although all women
were keen to have a healthy child, they seemed to lack understanding of the
relationship between a high CD4 count and low chance of transmission of HIV to
offspring.
The discussion is reflective and provides interesting comparative data.
Methodological considerations are also covered in detail, with suggestions for
further study.
I found this a fascinating paper, which provides a revealing insight into the
motivations of HIV-positive women who conceive before attaining optimal CD4
status whilst taking anti-retroviral therapy. My only criticism is that the authors
highlights the nature of the problem, but does not seem to offer a solution, which
may require better education about the relationship between CD4 count and risk
of transmission to offspring.
The paper is appropriately referenced and illustrated.
Recommendation
I do not suggest revisions other than for the authors to consider adding to the
discussion a brief exploration of the possible means of influencing the decisions
of women with HIV who wish pregnancy in the future.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.