Social norms informing contraceptive use among women living with HIV in ilala district, Dar es Salaam, Tanzania

Abstract

Background: Women Living with HIV (WLHIV) make contraceptive choices within complex social contexts shaped by relational and community norms. The study aimed to examine how social norms influence contraceptive use decisions among WLHIV in the Ilala District, Dar es Salaam, Tanzania.

Methods: A cross-sectional qualitative study was conducted from May to June 2025 among 15 women of reproductive age living with HIV who attended Care and Treatment Clinics in Ilala District, Dar es Salaam, Tanzania. Data were collected through in-depth interviews, and participants were purposively selected using maximum variation sampling. Interviews were audio-recorded, transcribed verbatim, and analyzed inductively using NVIVO 14. Ethical approval was obtained, and all participants provided written informed consent.

Results: Fifteen WLHIV, aged 19–42, participated in the study. Most were married, with primary or secondary education, and engaged in various livelihoods. Contraceptive decisions were influenced by social norms from interpersonal, relational, and community levels. Gender roles limited reproductive autonomy and led to covert use. Peer networks provided both misinformation and support. Community stigma and family silence reinforced secrecy and restricted open discussion. Some women reported supportive partners, peers, and healthcare providers who aided open decision-making. Secrecy was a common, but not universal, strategy to manage social expectations about fertility, sexuality, and HIV.

Conclusion: Contraceptive decision-making among WLHIV is shaped by social and relational factors beyond access to services. Supporting reproductive autonomy requires addressing stigma, communication, and social relationships. More research across diverse settings is needed to understand how these factors affect reproductive experiences.