By Anders Kelto On the eastern side of Kenya's capital, Nairobi, is a sprawling slum called Uhuru. Dirt roads run through a maze of shacks. Down a narrow path, Lilian Akoth stands in the doorway of her metal shanty. A number of years ago, she got pregnant. "I went to the hospital and tested positive for HIV," she says. "When I got back home and told my husband about it, he was very angry." She says her husband did not want her to have the baby. He did not want a child with HIV. When Lilian said she wanted to have the baby anyway, he beat her. He said she was cursed with HIV, and the baby would also be cursed. He punched her in the stomach many times. She miscarried. Lilian's experience was extreme, but the problem she faced is common in Africa. Many HIV-positive women say they have been pressured — even forced — not to have children because people assume they will infect their babies. Mitch Besser, an American obstetrician now based in South Africa, says many people in Africa are not aware that HIV doesn't have to pass from mother to child. "Most babies (from HIV-positive mothers) are born HIV-negative," he says. "With effective interventions, essentially all babies can be born HIV-negative." Besser has founded an organization called Mothers2mothers that helps women get those interventions — HIV testing, and antiretroviral drugs to prevent the virus from spreading to the child. Carol Mutune is a counselor with Mothers2mothers. She says there's another reason HIV-positive women are pressured not to get pregnant. People in their communities fear the mother will die, leave the child an orphan, and "they will be left to take the responsibility of that child." Yet Mutune says it's not fair to assume that the mother will die prematurely. In many parts of Africa, antiretroviral drugs are now widely available, and many people with HIV are living long and healthy lives. Still, even some doctors act as though that's not the case. Ruth Adhiambo is also a counselor with Mothers2mothers. She says physicians often tell HIV-positive women to get tubal ligations. "They don't want you to get another baby, because they believe that you are going to die," she says. "I think it is lack of information, and they still practice the things that were being practiced in 1980's or in 1990's." Across the continent, there have been organized efforts to prevent HIV-positive women from having children. In Western Kenya, an American organization is paying poor women with HIV to go on long-term birth control. In Namibia, several doctors have been accused of sterilizing HIV-positive women without their consent. And in Uganda, the government is considering a bill that would make it a crime for people to transmit HIV, including mothers who infect their children. Supporters of these efforts say it is irresponsible for HIV-positive women to get pregnant, when many of them still do not have access to antiretroviral drugs. But AIDS activists say that instead of pressuring HIV-positive women not to have kids, more should be done to ensure that everyone has access to treatment. Back in Nairobi, Lilian Akoth says that after her first husband beat her and she miscarried, she got a divorce. She married a new husband who was supportive of her desire to have kids. She got pregnant, took antiretroviral drugs, and now has two boys. Teddy is two. Kevin is four. Neither has HIV. Lilian faces one last challenge. Most of her family does not believe that the boys are HIV-negative. But she's confident that, in time, they'll believe.

Lilian Akoth standing outside her metal shanty with her son Teddy in her arms and other son Kevin beside her. (Photo: Anders Kelto)

Lilian Akoth standing outside her metal shanty with her son Teddy in her arms. (Photo: Anders Kelto)

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