Table 3.

Barriers and facilitators to uptake of safer conception

Barriers	Negative perceptions	“Caution will be thrown in the wind because the drug is there, eventually they might fail to get the drug and get the disease.” [Female, age 28, not in HIV-affected relationship, IDI]
	Fear of HIV transmission	“Some people are positive but desire to have children. There are those who are positive but live in fear. They fear that they will give birth to a HIV positive child.” [Female, age 37, HIV-affected relationship, women FGD]
	Fear of unfamiliar procedures	“Such a thing [non-intercourse vaginal insemination] has never happened in our community. I don't think it can happen. It is good. However, it is meant for other people-not in my community. You cannot suck the sperms and later insert in the vagina … Such things will scare the hell out of our community members.” [Female, age 47, not in HIV-affected relationship, women FGD]
	Stigma against HIV	“Number one [barrier] is stigma, the fear that people might have approaching the health practitioners or discussions that might lead to couples reaching a consensus to that kind of a plan. So stigma plays a big role in the whole thing.” [Male, age 30, not in HIV-affected relationship, IDI]
	Lack of SCS information	“It is true that the information that we lack is the source of our problem because we do not know what to do. We don't have an idea of what is to be done. And that is what is bringing to us a lot of problems.” [Male, age 24, HIV-affected relationship, men FGD]
	Financial barriers	“Key number one is the cost implications. If there will be costs involved in it … Majority of people like free things, if the services can be offered for free then they will come for them.” [Male, 30, HIV-affected relationship, IDI]
	Barriers to vaginal insemination and sperm washing	“In the Bible, it is abomination when you are having sex with a woman … even without having condoms and then you want to release outside … NO! According to the Bible, according to the Luo culture, you have to release inside … To take the sperm of a Luo man … I don't think that will happen.” [Male, age 51, not in HIV-affected relationship, initial community leader FGD]
	Lack of male involvement	“I think it is tricky here because if you were to use health facilities, most men will not go to these health facilities and especially the cases whereby the man is the one who is negative. There [that] is a problem.” [Male, age 50, not in HIV-affected relationship, initial community leader FGD]
Facilitators	Education	“The discussion has been fruitful to me. At least I have learnt things which are new and I didn't know. I have also got rid of some negative perceptions that I had. I am now clear on that. On that note, I think I am now better placed to do the dissemination of this information to the community.” [Female, age 24, FGD, not in HIV-affected relationship, youth FGD]
	Comparison to previous HIV-prevention interventions	“I think let's be realistic. Things have happened and the world is evolving. When the condom concept was brought into the community, there was quite a lot of resistance. Especially from the religious leaders … And they were actually preaching against it within the institutions. What is happening now about use of condoms? They are selling it and it is being used like a hot cake.” [Male, age 44, HIV-affected relationship, initial community leader FGD]
	Success stories and testimonials	“But as Luos say, people must always come to witness for themselves. I think they can easily encouraged if they see those who are in HIV-affected relationships getting healthy children. They will be encouraged and anyone who is positive will try their best to succeed in getting a child.” [Male, age 23, not in HIV-affected relationship, youth FGD]
	Community mobilization	“So, we should have such discussions everywhere in the community so that we all get the right information. We need the community members to have hope in life.” [Female, 48, not in HIV-affected relationship, community leader FGD]