Living with HIV post-diagnosis: a qualitative study of the experiences of Nairobi slum residents

Objectives: To characterise the experiences of heterosexual men and women living with HIV post-diagnosis and explain these experiences in relation to their identity and sexuality. Design: Qualitative study using in-depth interviews and theoretically informed biographic disruption theory. Setting: Interviews were conducted in two Nairobi slums (Kenya). Participants: 41 HIV-infected heterosexual men and women aged 18 years or older Results: People living with HIV have divergent experiences surrounding HIV diagnosis. Post-diagnosis there are multiple phases of identity transition, including status (non-)disclosure, and attempts at identity repair and normalcy. For some people this process involves a transition to a new self-identity, incorporating both HIV and antiretroviral treatment (ART) into their lives. For others it involves a partial transition, with some aspects of their pre-diagnosis identity persisting, and for others it involves a rejection of HIV identity. Those people who were able to incorporate HIV/AIDS in their identity without it being disruptive to their biography, were pursuing safer sexual and reproductive lives. By contrast, those people with a more continuous biography continued to reflect their pre-diagnosis identity and sexual behaviour. Conclusions: People living with HIV/AIDS (PLWHA) had to rework their sense of identity following diagnosis in the context of living in a slum setting. Men and women living with HIV in slums are poorly supported by health systems and services as they attempt to cope with a diagnosis of HIV. Given the availability of antiretroviral therapy, health services and professionals need to support the rights of PLWHA to be sexually active if they want to and achieve their fertility goals, while minimizing HIV transmission risk.