Diane D Cooper

University of the Western Cape | uwc · School of Public Health

Study objective To investigate whether contraceptive service uptake (including current contraceptive use), unmet need for contraception, unintended pregnancy, preferences for service provision and providers among female adolescents living with HIV (ALHIV) vary with HIV-acquisition route, that is, perinatal HIV acquisition versus horizontal HIV acqu...

Purpose: This paper used data from the Global Early Adolescent Study (GEAS) to provide a descriptive analysis of how early adolescents' social environments vary by sex across diverse cultural settings. Methods: The analyses were based on baseline data among 10-14-year old adolescents living in disadvantaged urban areas in seven sites: Kinshasa (...

Study Objective: To investigate whether current contraceptive uptake, unmet need for contraception, and unintended pregnancy among female adolescents living with HIV (ALHIV) vary with the model of access sites for HIV-related services, that is, stand-alone youth clinics (YCs) versus general primary health clinics (PHC). Design: Exit interviews. Set...

Teenage childbearing interferes with girls’ educational attainment in many settings, as it frequently marks the end of their basic education. In Seychelles despite numerous laws and policies to facilitate and support teenage mothers’ schooling, the number of teenage mothers returning to school remains low. We are unaware of the factors that may be...

Aims To understand the impact of urban violence and crime on HIV care delivery. Background Urban violence and crime can put pressure on the health care system and on nursing staff. Whilst the impact this has at the individual level has been researched, there is less research that places this within the context of the overall social eco‐system. De...

Background: The uptake of findings from sexual and reproductive health and rights research into policy-making remains a complex and non-linear process. Different models of research utilisation and guidelines to maximise this in policy-making exist, however, challenges still remain for researchers to improve uptake of their research findings and for...

The objective of this study is to measure the preliminary efficacy of a pilot intervention, grounded in behavioural economics, increasing adherence of dual protection (simultaneous use of effective modern contraception and a barrier method, such as a condom) to protect against HIV, other sexually transmitted infections, and unintended pregnancy. Be...

Presentation to international AIDSImpact 2017 on providers’ perceptions of the potential effects of urban violence and crime on youth access to SRH and particularly ART services

Introduction: Safer conception care encompasses HIV care, treatment and prevention for persons living with HIV and their partners who desire children. In 2012, South Africa endorsed a progressive safer conception policy supporting HIV-affected persons to safely meet reproductive goals. However, aside from select research-supported clinics, widespre...

Integration of sexual and reproductive health within HIV care services is a promising strategy for increasing access to family planning and STI services and reducing unwanted pregnancies, perinatal HIV transmission and maternal and infant mortality among people living with HIV and their partners. We conducted a Phase II randomized futility trial of...

As a 'case-study' to demonstrate an approach to establishing a fertility-intent prediction model, we used data collected from recently diagnosed HIV-positive women (N = 69) and men (N = 55) who reported inconsistent condom use and were enrolled in a sexual and reproductive health intervention in public sector HIV care clinics in Cape Town, South Af...

This paper is a sequel to a 2004 article that reviewed South Africa’s introduction of new sexual and reproductive health (SRH) and rights laws, policies and programmes, a decade into democracy. Similarly to the previous article, this paper focuses on key areas of women’s SRH: contraception and fertility, abortion, maternal health, HIV, cervical and...

Background: In the lives of women, puberty is marked by the onset of menarche. From this stage onwards until menopause, reproductive health and menstrual hygiene are important aspects of women's lives. In Zambia's Western Province, the natural process of menstruation is a taboo and dealt with secretly. Information and knowledge about menstruation...

The South African National Department of Health has rapidly extended free public sector antiretroviral treatment for people living with HIV from 2007. Approximately 6 million people are living with HIV in South Africa, with 3.1 million currently on treatment. HIV disclosure stigma has been reduced in high prevalence, generalized epidemic settings,...

Integration of sexual and reproductive health (SRH) and HIV policies and services delivered by the same provider is prioritised worldwide, especially in sub-Saharan Africa where HIV prevalence is highest. South Africa has the largest antiretroviral treatment (ART) programme in the world, with an estimated 2.7 million people on ART, elevating South...

Despite the documented relationship between hegemonic norms of masculinities and South African men’s use of sexual violence, less is known about how women’s engagement with norms of masculinity influences their agency in sexually coercive experiences. This study applied a narrative approach to assess how women’s understandings of hegemonic male nor...

Male partner involvement (MPI) has been identified as a priority intervention in programmes for the prevention of mother-to-child transmission (PMTCT) of HIV, but rates of MPI remain low worldwide. This study used a quantitative survey (n = 170) and two focus group discussions (FGDs) with 16 HIV-positive pregnant women attending a public sector ant...

The frequent positioning of men’s sexual risk-taking as driving the HIV/AIDS epidemic in South Africa has triggered interest in men’s sexual and reproductive health (SRH) perceptions, attitudes, and practices. Much research, however, presents men as a homogenous group, and focuses on the quantifiable aspects of male sexual behaviors, providing an i...

Sexual and reproductive health (SRH) services for HIV-positive women and men often neglect their fertility desires. We examined factors associated with pregnancy intent among recently diagnosed HIV-positive women (N = 106) and men (N = 91) who reported inconsistent condom use and were enrolled in an SRH intervention conducted in public sector HIV c...

HIV makes a significant contribution to maternal mortality, and women living in sub-Saharan Africa are most affected. International commitments to eliminate preventable maternal mortality and reduce HIV-related deaths among pregnant and postpartum women by 50% will not be achieved without a better understanding of the links between HIV and poor mat...

Background Within the health system, limited attention is given to supporting the fertility and parenting desires on HIV-positive people. In this study, we explore health care providers’ knowledge and perspectives on safer conception and alternate parenting strategies for HIV-positive people. Methods Between November 2007 and January 2008, in-dept...

While much research has documented unsatisfactory sexual and reproductive health (SRH) awareness among young people in South Africa, understanding of gender differences in access to and evaluation of SRH information is limited. This paper concerned itself with men and women’s informal sources and content of SRH, and gendered divergences around acce...

While sexual abuse against women and girls in South Africa has generated much deserved attention, the awareness of men's experiences of sexual coercion is limited, and often restricted to a homosexual context. This article illuminates men's experiences of pressurized sex in a heterosexual context, which were revealed in a broader men's sexual healt...

Given the pivotal role of first sex in the development of sexual and reproductive health (SRH) practices, there is a need for more contextualised and nuanced understandings of young people's early sexual debut experiences. This study used sexual history narratives to investigate how South African men and women experience and attribute meaning to th...

Despite abortion being legally available in South Africa after a change in legislation in 1996, barriers to accessing safe abortion services continue to exist. These barriers include provider opposition to abortion often on the grounds of religious or moral beliefs including the unregulated practice of conscientious objection. Few studies have expl...

Within the health system, limited attention is given to supporting the fertility and parenting desires on HIV-positive people. In this study, we explore health care providers' knowledge and perspectives on safer conception and alternate parenting strategies for HIV-positive people. Between November 2007 and January 2008, in-depth interviews were...

Background: While much research has documented the unsatisfactory sexual and reproductive health (SRH) awareness among young people in South Africa, the understanding of gendered differences in terms of access to and reception of SRH information is limited. This paper concerns itself with participant's sources and content of information around sex...

This paper explores notions of fatherhood and their linkages to fertility desires and intentions among a treatment-naïve cohort of Xhosa-speaking male key informants living with HIV, aged 20-53 in Cape Town, South Africa. Analysis is based on an initial 27, and 20 follow-up, interviews with men who were part of a study that assessed the acceptabili...

This paper explores marriage attitudes and practices among Xhosa-speaking women living with HIV (WLHIV) in Cape Town, South Africa. It reports on a study that assessed the fertility intentions of a cohort of people living with HIV, aimed at informing an HIV care intervention. It draws on qualitative data generated from 30 successive interviews with...

In many areas of the world where HIV prevalence is high, rates of unintended pregnancy and unsafe abortion have also been shown to be high. Of all pregnancies worldwide in 2008, 41% were reported as unintended or unplanned, and approximately 50% of these ended in abortion. Of the estimated 21.6 million unsafe abortions occurring worldwide in 2008 (...

Developing and testing safer conception methods that reduce HIV transmission to HIV-seronegative partners in serodiscordant couples and reduce superinfection in HIV-seroconcordant couples is a crucial but often unaddressed component of HIV prevention programs. Most research has focused on developed-world settings, where "high-technology" assisted r...

Research was conducted with 36 women living with HIV in Cape Town, South Africa, regarding their decision-making about, and experiences with, abortion of unwanted pregnancies in the public health sector. Abortion intentions and decisions were explored by investigating influencing factors; knowledge of abortion policy and public health sector servic...

Ninety years ago the isolation of insulin transformed the lives of people with type 1 diabetes. Now, models based on empirical data estimate that a 25-year-old person with HIV, when appropriately treated with antiretroviral therapy, can expect to enjoy a median survival of 35 years, remarkably similar to that for someone of the same age with type 1...

Ninety years ago the isolation of insulin transformed the lives of people with type 1 diabetes. Now, models based on empirical data estimate that a 25-year-old person with HIV, when appropriately treated with antiretroviral therapy, can expect to enjoy a median survival of 35 years, remarkably similar to that for someone of the same age with type 1...

HIV-positive women's abortion decisions were explored by: (i) investigating influencing factors; (ii) determining knowledge of abortion policy and public health services; and (iii) exploring abortion experiences. In-depth interviews were held with 24 HIV-positive women (15 had an abortion; 9 did not), recruited at public health facilities in Cape T...

The study describes the association between risk factors and quantitative ultrasound bone measures in black and mixed-race pre-menopausal South African women. Despite some differences between the two study groups, the findings generally lend support to the use of ultrasound for epidemiological studies of bone mass in resource-limited settings. Intr...

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 s...

Background Addressing HIV-infected individuals’ reproductive health needs is an urgent concern in countries with advanced HIV epidemics, where a sizeable population early in their reproductive years is already HIV-positive. While access to antiretroviral drugs has begun to normalize the lives of HIV-infected people, issues of contraception and chi...

Our aim with this study was to explore the factors that contribute to tuberculosis patients' adherence and nonadherence to the Directly Observed Treatment Short Course strategy. A qualitative, phenomenological research design was used. Fifteen male and female participants between the ages of 18 and 57 years were recruited through purposive sampling...

South Africa's Choice on Termination of Pregnancy Act of 1996 provides for safe termination of pregnancy (TOP) in designated facilities in the public and private health sectors. In 2001, mifepristone-misoprostol medical abortion was approved for TOP up to 56 days, but this method is not yet available in the public sector. Information on the operati...

Qualitative research was conducted with HIV-positive women and men of reproductive age attending HIV/AIDS care and treatment services at a public health clinic in Cape Town, South Africa. Focus group discussions were held with women (n = 4) and men (n = 4), and in-depth interviews were held with four men to explore perceptions and experiences of HI...

To help fill the gap concerning health care providers' and policy makers' knowledge of and views concerning microbicides, we compared data from one U.S. study and two South African studies that explored these issues. Frontline providers in South Africa were enthusiastic about any method that would have the potential to slow the HIV/AIDS epidemic, w...

Rights, health and development are interrelated, as health services on their own cannot ensure a healthy population. The fulfilment of socio-economic rights—to employment, education, food, water and shelter—is critical to staying healthy (Singh et al, 2003:5). Social service provision savings from sexual and reproductive health (SRH) interventions...

Women using injectable progestin contraceptives (IPCs) have lower bone mineral density than nonusers. We assessed whether bone loss is completely reversible after cessation of IPC use, whether different IPCs have different effects and whether effects vary by age at first use. In a cross-sectional study in Cape Town, South Africa, 3487 premenopausal...

Background:Tailoring reproductive health policy and services for HIV positive women and men is pressing in countries where a sizeable reproductive age population is HIV positive. Accelerated roll-out of prevention of parent to child transmission and ARV treatment programs in developing countries heightens this need. Methods:In a survey conducted in...

This article reports on qualitative research investigating HIV positive individuals' reproductive intentions and their influencing factors in Cape Town, South Africa. In-depth interviews were held with 61 HIV positive women and men; at the time of interview, half had been receiving antiretroviral treatment (ART) for over 6 months and half were not...

To compare providers' and women's estimates of duration of pregnancy with ultrasound estimates for determining medical abortion eligibility. Cross-sectional study. Public termination of pregnancy (TOP) services in three provinces. A total of 673 women attending the above services for TOP. Women participating in a medical abortion feasibility study...

Invasive cervical cancer is the commonest cause of cancer morbidity and mortality in South African women. This study provides information on adult women's sexual activity and cervical cancer risk in South Africa. The data were derived from a case-control study of hormonal contraceptives and cervical cancer risk. Information on age of sexual debut a...

Worldwide there is growing attention paid to the reproductive decisions faced by HIV-infected individuals. Studies in both developed and developing countries have suggested that many HIV-infected women continue to desire children despite knowledge of their HIV status. Despite the increasing attention to the health care needs of HIV-infected individ...

Emergency contraception (EC) is widely available free of charge at public sector clinics in South Africa. At the same time, rates of teenage and unintended pregnancy in South Africa remain high, and there are few data on knowledge of EC in the general population in South Africa, as in other resource-limited settings. We conducted a cross-sectional,...

While the ability to lead a healthy sexual life and to choose whether and when to have children are well-established features of reproductive health and human rights, issues surrounding sexual activity and childbearing among HIV-infected women and men have received little attention in sub-Saharan Africa. We conducted a semi-structured, cross-sectio...

Qualitative research was conducted in South Africa to determine perceptions about intra-vaginal microbicides in order to better understand the socioeconomic, cultural and structural contexts for the support of future introduction of this new HIV prevention method. Focus group discussions and in-depth interviews were conducted at community, health s...

Cervical cancer and infection with human immunodeficiency virus (HIV) are both major public health problems in South Africa. The aim of this study was to determine the risk of cervical pre-cancer and cancer among HIV positive women in South Africa. Data were derived from a case-control study that examined the association between hormonal contracept...

Medical abortion is safe and effective and has been approved for use in early termination of pregnancy in South Africa since 2001. The Department of Health is currently considering its introduction in the public health sector. The attitudes of women seeking abortion and of health care providers towards medical abortion have not previously been desc...