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To address this gap, this study used a qualitative study design to examine patterns and strategies for dating, marriage, and parenthood among 24 HIV-positive heterosexual Puerto Rican men living in Boston. The findings in our study indicate that an HIV diagnosis does not necessarily deter men from having an active sexual life, marrying, or having children.

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In fact, for some of the men, engaging in these social and life-changing events is part of moving on and normalizing life with HIV; these men planned for, achieved, and interpreted these events in the context of establishing normalcy with HIV. Although the HIV diagnosis discouraged some men from engaging in sexual relations, getting married, or having children, others fulfilled these desires with strategies aimed to reconciling their HIV status in their personal life, including dating or marrying HIV-positive women only. Additional important themes identified in this study include the decision to disclose HIV status to new sexual partners as well as the decision to accept the risk of HIV transmission to a child or partner in order to fulfill desires of fatherhood.

Understanding the personal struggles, decision-making patterns, and needs of HIV-positive heterosexual men can aid in designing interventions that support healthy living with HIV. Despite challenges, an HIV diagnosis does not preclude dating, marrying, or having a family.

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However, while these studies mostly document negative experiences, such as stigma and discrimination, little is known about the social adaptations to living with HIV in everyday life, particularly with regard to dating, marriage, and parenthood. The present article reports on findings from a qualitative research study that examined the social lives of a group of HIV-positive heterosexual Puerto Rican men in Boston, Massachusetts.

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The overall aim of this study was to explore positive adaptations to living with HIV as a chronic illness. By examining how heterosexual men approach dating, marriage, and parenthood following an HIV diagnosis, this article aims to contribute to the scarce literature on the experience of illness of HIV-positive heterosexual men. Specifically, the authors describe the strategies of reconciling living with HIV into everyday life by examining the personal lives of this group of men.

Our analysis is set within a discussion of the experience of illness framework Pierret, exploring the concept of normalcy to expand previous work on the incorporation of HIV into everyday life Baumgartner, The research community has posited important questions about how people manage life after a diagnosis: The impact of illness on everyday life has been the focus of many studies that examine the adjustments people make when facing an incurable illness Nack, ; Shaul, ; Townsend, ; see also Charmaz, ; Larsen, This body of research demonstrates that people with chronic illness follow an adjustment process that involves strategies Royer, for redefining a sense of normalcy that coincides with the level of functioning determined by the condition.

More precisely, Miller describes the process in terms of transformation and adaptation, that is, the adjustment involves developing the ability to see life with illness, including the accompanying changes and challenges, as normal. In the case of HIV, diagnosis is a life-changing event accompanied with feelings of despair and loss. Negative experiences, including stigma, isolation, and rejection, are common among people living with HIV Herek et al.

Dating and marriage after an HIV diagnosis is challenging; often, HIV-positive men face many issues when trying to reengage in sex and meeting life partners. Much of the literature on relationships among HIV-positive men, mostly based on studies with men who have sex with men MSM , have noted the difficulties and tension of finding a partner and disclosing the HIV status. Hatala, Baack, and Parmenter identified that even when using dating sites where anonymity is possible e. These studies have identified that men either avoid sex altogether, engage in casual sex-only relationships, or become involved in committed or long-term relationships Relf et al.

Seroconcordant relationships, where both partners are HIV-positive, can offer emotional and health protective benefits, along with eliminating the risks and anxiety associated with disclosure Relf et al. Although a great volume of research has been conducted on relationship choices among men living with HIV, the majority of the work has focused on MSM populations. Fatherhood is important in the lives of HIV-positive men.

The desire to father children is particularly greater among men without children in comparison with men who had fathered children prior to their diagnosis Chen et al. In this regard, research has identified that although advances in medical science can reduce the risk of transmission Cohen et al. To our knowledge, no studies have been conducted in the United States that examine dating, marriage, and parenthood among Latino HIV-positive heterosexual men as they normalize their lives within the context of HIV.

To begin addressing this gap in the literature, qualitative method was used to examine how a group of heterosexual HIV-positive Puerto Rican men engage in dating and approach marriage and family planning. The findings presented in this article are part of a larger ethnographic study investigating the positive impact of illness among a group of HIV-positive Puerto Rican men living in Boston. The qualitative study consisted of three phases of data collection: Phase 1 exploratory research using focus groups, followed by Phase 2 semi-structured in-depth interviews, and Phase 3 a town-hall meeting format presentation to validate the study findings.

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Participants from the exploratory focus groups Phase 1 were excluded from the in-depth interviews Phase 2. This article reports on findings from 24 in-depth interviews conducted during the second phase of research. A total of 31 interviews were conducted with HIV-positive Puerto Rican men during that phase of research. In efforts to focus our research on heterosexual men, 7 participants who self-identified as gay during the interview were excluded from the analysis.

Interviews were semistructured and open-ended to explore key research topics. The participants were asked questions about living with HIV, including their experiences of illness, stigma, and life changes since their diagnosis. The major objective of the interviews was to explore how these men live with HIV as a chronic illness and, specifically, to document everyday living with HIV.

The interviews included a short questionnaire to collect general demographic information and HIV history. Interviews were conducted in the preferred language of the respondent, the majority of which chose Spanish. Only two interviews were conducted in English. Potential participants were informed about the study by program staff and by flyers posted at the agencies. Interested participants contacted the lead author and were then screened to determine eligibility. Additionally, individuals had to be able to give informed consent to participate. Despite the limitations of convenience sampling Marshall, , the study captured variation in the sample in terms of place of birth, mode of HIV transmission, and length of time living with HIV, in addition to other common socioeconomic indicators see Table 1.

A Certificate of Confidentiality was obtained to ensure maximum protection for study participants. The participants were asked for and gave informed consent prior to participating in the study. The names that appear throughout this article are pseudonyms to protect participant identities. To maintain the integrity of the data, the interviews were audio recorded and transcribed.

All the participants agreed to be recorded and each session was transcribed using the original language. The coding of the transcripts was completed in the original language of the interview. After the analysis, selected passages from the interviews were translated into English to be included in the text of this article. Given the original language of these interviews and in an effort to maintain accuracy while reporting these results, the quotations were translated without regard to prescriptive rules of English syntax.

The translations were completed by an independent translator. All the translations were checked and edited for accuracy by the lead author. The data management, coding, and analysis were done using Atlas. The data analysis was conducted in three stages. First, prior to initiating a systematic data analysis of the transcriptions, a precoding stage was performed. At this stage, particular attention was directed toward identifying patterns in the data: The patterns and themes observed during this exploratory stage were documented using the Memo function in Atlas.

Memos were then used as codes to link them directly to the text during the coding stage. The second step consisted of coding the text for emergent themes following an inductive approach Thomas, to document strategies for adjusting to living long-term with HIV and for coping with the stigmatized notions attached to the illness. Finally, to complement the systematic qualitative data analysis, additional data mining techniques were performed to explore the data for additional patterns and themes. This stage primarily included a quotation frequency analysis, a report of the number of instances that any given code was used to determine coding trends.

This analysis was central to uncovering the themes described in this article. What follows is a rich, qualitative description of the experiences of 24 Puerto Rican heterosexual men as they reconcile their HIV status into their personal and social lives. That is, despite the diagnosis and stereotypes of illness, these men exercise agency through everyday practices in normalizing their social lives to redefine what it means to live with HIV. The experiences shared by the men are organized thematically into three main categories to describe, in the context of HIV, a dating and sex, b marriage, and c fatherhood.

Entering the dating world and, particularly, having intimate relationships was reported to be difficult after an HIV diagnosis by some of the participants in the study.

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Many of the interviewed men remarked that disclosing HIV status to potential partners was challenging. Often, such disclosures were received with rejection, motivating censorship from seeking romantic relationships. You know, perhaps for the fear of being rejected. That the illness was like cancer or other illness. Not all men rejected relationships completely once diagnosed. One man listed his options to ease the fear of disclosure and prevent exposing others to HIV:. I know people that are healthy and are with others who are HIV, but it is a big risk.

I cannot take a risk like that. I prefer … to use my five fingers showing his right hand to indicate masturbation or to look for a stripper and wear a condom, or look for a person that is like me HIV-positive. Other participants in the study took a similar approach opting to dating exclusively HIV-positive women.

Given this scenario, one man elected relationships that perhaps would have never been considered prior to being diagnosed with HIV. To look for a transsexual! However, he felt it was safe and convenient given that this person was also HIV positive. Other men in the study did not feel an HIV diagnosis necessarily prevented or limited them from having active social lives and intimate relationships with HIV-negative women.

Although open to engaging in serodiscordant relationships, some men opted to keep their HIV status secret from their partners. However, disclosure became unavoidable in a long-term relationship, as in the case of Luis:. Not all men followed the same delayed disclosure strategy. In fact, he believed that being honest about his HIV status was important to his success with women.

These narratives illustrate varying approaches to dating, including ending current relationships, ceasing to look for a partner, exclusively dating HIV-positive individuals, or continuing a relatively typical dating life. Marriage was another aspect that men reported having to reassess after their diagnosis. While in jail, he had time to evaluate the impact of being diagnosed with HIV on his life projects.

I had a plan for my life to be married with a wife, but that has changed. Thinking in prison, all the suffering, and needing a partner because I was there for many years and I need to enjoy being with a woman and having children. HIV also destroyed that plan. The men reporting a marriage after being diagnosed, the majority married based on disease status.

Sixty-seven percent of the married participants had spouses who were also infected with HIV. Reinforcing the dating preference noted above, the men explained that being married to someone who is also HIV-positive eliminates potential problems and creates a sense of normalcy. You know, in a normal day, I feel normal because my partner, we are both same … have the same disease. Because of the frustration of not getting her … not getting the person sick, you know.

To me it does. Marrying an HIV-negative person also presents challenges. Several men described the issues of concern when the spouse is not HIV-positive. For example, one participant noted the importance of discussing the implications of HIV on marriage before they wed. He went through great lengths to make sure she was aware of the implications and potential consequences:.

I explained to her that this is an illness that is very very very severe and I told her that she can die also if she has contact with my blood. She can also get the same thing. At the end, we both went to counseling. She accepted me and we were married. Benedicto described his strategy for a healthy relationship despite his HIV status. His approach involved speaking to his girlfriend about the challenges, discussing the potential risks, and seeking counseling. Not all men follow the same approach when laying the foundation for a marriage.

We had problems, but later she started looking for information. I also gave her information and then she … we got back together because she loves me and I love her. She is still not HIV-positive. During the interview, Orlando commented that he did not disclose his HIV status prior to his wedding because of fear of rejection. In this case, information about HIV and acceptance were crucial to mending the relationship once he disclosed his HIV status. Fatherhood varied among the men in the study see Table 2. Participants who were fathers had 2. One participant, Manny 42 years old , reported having five children and was expecting his sixth child at the time of the interview.

None of the children were reported as being HIV-positive. Several participants pointed their HIV status for the strong apprehensions to having a family. For example, Luis had not given up on the idea of one day having a family, but he realized that HIV made it more difficult to have children:. I want to have a son or a daughter. It can be done, but you have to follow a procedure, you have to find the right person. Those are long term goals. My body is not the same like the body of a normal person. Like Luis, the potential for HIV transmission was a major concern voiced by other men in the study.

Because of their HIV status, many participants opted against having any or additional children because of the potential risk of infecting the child regardless of medical treatments available. Yet this was not a universal belief among the participants. For example, for Diego, having children was a calculated risk he was willing to take to please his wife. She wanted to take a chance and have a child.

The child is three months, thank God…. When we went to the doctor, the doctor told her that the baby was negative because she took the medications. In an effort to prevent transmission, another man explored safer options available for fatherhood. Minor looked into the most advanced medical procedures available to reduce the risk of transmission. This is something Benedicto and his wife experienced while having their first child:. We went to counseling. We went to counseling for medications and we were told the percentage that she could become HIV positive.

So, we had our son. Although HIV has been at the forefront of public health discourse for roughly 30 years, approaches to living with HIV only date back to the late s, when advances in medical treatment altered the outcome of an HIV diagnosis. Our data support theorists and researchers in that the men in this study are living with , instead of dying from HIV, reasserting the notion of HIV as a chronic illness instead of a death sentence. The chronicity of HIV is underscored in how people manage to live after a diagnosis and work to establish a sense of normality within the context of living with the illness.

The importance of normalizing life is highlighted by the qualitative findings of this study. For many of the men in this study, moving beyond the diagnosis implies moving on with life and engaging in everyday social aspects of life such as dating and sex, marriage, and parenthood. The findings in our study indicate that being HIV-positive does not necessarily deter most men from having an active sexual life, marrying, or having children. What is the transmission rates in heterosexual contact, and Bob,I just read a response to another person and you said "CMV is a late complication This Month in HIV: A recent increase in the number of heterosexual ly acquired HIV infections among non-Aboriginal person s has been noted in Western Australia WA but not in other jurisdictions of the country, the authors wrote.

The Feminization of an Epidemic People who are diagnosed earlier also have a lower You'd never find that at a straight positive social.