Table 3 Meta-themes, themes, and subthemes

Shattered Identity

Womanhood

I’m shocked

I don’t feel like a woman anymore

Permanence of HIV

Loss of normality

Broken plans

Reduced sexual desire

Motherhood

Becoming mothers as a route to normality

Missed mothering opportunities

Motherhood as a social responsibility

Motherhood as a personal desire (value and identity)

Barriers, Inequities, and Misinformation

System barriers

External barriers preventing access to care

Clinician barriers

Negative support from healthcare providers

They never asked me if I want to have a baby

Coercion and concealment

Inadequate information

Need for information

Weighing the different options

Individual barriers

Knowing about HIV

Knowing about conception methods

Incorrect beliefs about HIV and pregnancy

Uncertainty and fears

Fear of transmission

Fear of birth defects

Fear of leaving children alone

Guilt

Family barriers

Lack of familial support

HIV-related stigma

Stigmatizing and stereotyping

Self-isolating and internalizing stigma

Fear to disclose, will be rejected

Gender-based inequalities

I just want to be loved

Unequal power in relationships

Socioeconomic barriers

Unstable situation

Coping, Resilience, and Support

Self-care and for caring others

Treatment adherence

Changes in sexuality: protecting others from HIV

Negotiating sex

Family planning

Planned pregnancy

Accidental/passive pregnancy

Avoiding recommendations

Child HIV + because of destiny

Creating empowering environments

Humanized healthcare providers

Partner support

Hope

Medical improvement as a hope

Motherhood is a hope and being a mother is reason to keep fighting HIV

A new life: second opportunity, another chance

Personal Choices

Protection of higher power/spiritual forces