Article

Fertility intentions and reproductive health care needs of people living with HIV in Cape Town, South Africa: implications for integrating reproductive health and HIV Care services

Women's Health Research Unit, School of Public Health & Family Medicine, University of Cape Town, Anzio Road Observatory, 7925, Cape Town, South Africa.
AIDS and Behavior (Impact Factor: 3.49). 05/2009; 13 Suppl 1(Suppl 1):38-46. DOI: 10.1007/s10461-009-9550-1
Source: PubMed

ABSTRACT Tailoring sexual and reproductive health services to meet the needs of people living with the human immuno-deficiency virus (HIV) is a growing concern but there are few insights into these issues where HIV is most prevalent. This cross-sectional study investigated the fertility intentions and associated health care needs of 459 women and men, not sampled as intimate partners of each other, living with HIV in Cape Town, South Africa. An almost equal proportion of women (55%) and men (43%) living with HIV, reported not intending to have children as were open to the possibility of having children (45 and 57%, respectively). Overall, greater intentions to have children were associated with being male, having fewer children, living in an informal settlement and use of antiretroviral therapy. There were important gender differences in the determinants of future childbearing intentions, with being on HAART strongly associated with women's fertility intentions. Gender differences were also apparent in participants' key reasons for wanting children. A minority of participants had discussed their reproductive intentions and related issues with HIV health care providers. There is an urgent need for intervention models to integrate HIV care with sexual and reproduction health counseling and services that account for the diverse reproductive needs of these populations.

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    • "Indeed, the lack of available, accessible and acceptable abortion services prevented some participants from successfully terminating their pregnancies, despite their desire to do so. There is broad support for the integration of HIV treatment and care with reproductive health services across health systems, but these discussions have largely neglected the delivery of abortion services even where it is legal (Cooper et al. 2009; Gruskin et al. 2008). "
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    ABSTRACT: Research on pregnancy termination largely assumes HIV status is the only reason why HIV-positive women contemplate abortion. As antiretroviral treatment (ART) becomes increasingly available and women are living longer, healthier lives, the time has come to consider the influence of other factors on HIV-positive women's reproductive decision-making. Because ART has been free and universally available to Brazilians for more than two decades, Brazil provides a unique context in which to explore these issues. A total of 25 semi-structured interviews exploring women's pregnancy termination decision-making were conducted with women receiving care at the Reference Centre for HIV/AIDS in Salvador, Brazil. Interviews were transcribed, translated into English and coded for analysis. HIV played different roles in women's decision-making. In all, 13 HIV-positive women did not consider terminating their pregnancy. Influential factors described by those who did consider terminating their pregnancy included fear of HIV transmission, fear of HIV-related stigma, family size, economic constraints, partner and provider influence, as well as lack of access to pregnancy termination services and abortifacients. For some HIV-positive women in Brazil, HIV can be the only reason to consider terminating a pregnancy, but other factors are significant. A thorough understanding of all variables affecting reproductive decision-making is necessary for enhancing services and policies and better meeting the needs and rights of HIV-positive women.
    Culture Health & Sexuality 01/2014; DOI:10.1080/13691058.2013.855820 · 1.55 Impact Factor
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    • "Improved health outcomes and near-normal life expectancies have resulted in people with HIV facing and making decisions about childbearing (Cooper et al., 2007; Maier et al., 2009). Research from sub-Saharan Africa suggests that the desire for children in the era of antiretroviral therapy (ART) ranges from 45 to 75% (Caroline et al., 2011; Cooper et al., 2009; Schwartz et al., 2012). Despite data suggesting people with HIV desire children, most programs have focused on integrating contraception and ART delivery but have not developed programs to specifically address fertility desires and safer conception. "
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    ABSTRACT: Improved health outcomes have resulted in people with HIV facing decisions about childbearing. We sought to understand the factors associated with desire for a child among men and women in Malawi. HIV-infected men and women ages 18-40 were invited to participate in a brief interview about fertility desires. Single variable logistic regression was used to evaluate the factors associated with the outcome of fertility desire. Additionally, multiple logistic regression was used to assess the relationship of all the factors together on the outcome of fertility desire. In-depth interviews with women were performed to understand experiences with reproductive health care. A total of 202 brief interviews were completed with 75 men (37.1%) and 127 women (62.9%), with 103 (51.0%) of respondents desiring a child. Being in a relationship (OR: 3.48, 95% CI: 1.58-7.65, p = 0.002) and duration of HIV more than two years (OR: 2.00, 95% CI: 1.08-3.67, p = 0.03) were associated with increased odds of desire for a child. Age 36-40 years (OR: 0.64, 95% CI: 0.46-0.90, p = 0.009) and having a living child (OR: 0.24, 95% CI: 0.07-0.84, p = 0.03) were associated with decreased odds of desire for a child. Seventy percent of women (n = 19 of 27 respondents) completing semistructured interviews who responded to the question about decision-making reported that their male partners made decisions about children, while the remainder reported the decision was collaborative (n = 8, 30%). Eighty-six percent of women (n = 36 of 42 respondents) reported no discussion or a discouraging discussion with a provider about having children. HIV-infected women and men in Malawi maintain a desire to have children. Interventions are needed to integrate safer conception into HIV care, to improve male participation in safer conception counseling, and to empower providers to help patients make decisions about reproduction free of discrimination and coercion.
    AIDS Care 11/2013; DOI:10.1080/09540121.2013.855294 · 1.60 Impact Factor
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    • "Third, FP services may prevent more pediatric infections and be more cost-effective than traditional approaches to PMTCT [1] [2]. Fourth, many African women want to limit total fertility and close birth spacing [9] [10]. Finally, FP use leads to increased economic and educational opportunities [11]. "
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    ABSTRACT: Objective Integrate enhanced family planning (FP) and prevention of mother-to-child HIV transmission (PMTCT) services in order to help HIV-positive Zimbabwean women achieve their desired family size and spacing as well as to maximize maternal and child health. Study Design HIV-positive pregnant women were enrolled into a standard-of-care (SOC, n=33) or intervention (n=65) cohort, based on study entry date, and followed for three months post-partum. The intervention cohort received education sessions aimed at increasing FP use and negotiation power. Both groups received care from nurses with enhanced FP training. Outcomes included FP use, FP knowledge, and HIV disclosure, and were assessed with Fisher’s exact, binomial, and t-tests. Results The intervention cohort reported increased control over condom use (p=0.002), increased knowledge about IUDs (p=0.002), increased relationship power (p=0.01), and increased likelihood of disclosing their HIV status to a partner (p=0.04) and having that partner disclose to them (p=0.04), when compared to the SOC cohort. Long-acting reversible contraception (LARC) use in both groups increased from ~ 2% at baseline to > 80% at three months post-partum (p<0.001). Conclusions FP and sexual negotiation skills and knowledge, as well as HIV disclosure, increased significantly in the intervention cohort. LARC uptake increased significantly in both the intervention and SOC cohorts, likely because both groups received care from nurses with enhanced FP training. Successful service integration models are needed to maximize health outcomes in resource-constrained environments; this intervention is such a model that should be replicable in other settings in sub-Saharan Africa and beyond. Implications This study provides a rigorously-evaluated intervention to integrate FP education into ante- and post-natal care for HIV-positive women, and also to train providers on FP. Results suggest that this intervention had significant effects on contraception use and communication with sexual partners. This intervention should be adaptable to other areas.
    Contraception 01/2013; 89(3). DOI:10.1016/j.contraception.2013.11.003 · 2.93 Impact Factor
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