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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"In recent years, there has been an increased focus on the psychosocial aspects of HIV-discordance (Persson 2008; Persson & Richards 2008; Rispel, Cloete, Metcalf, Moody & Caswell 2012; Rispel, Metcalf, Moody, Cloete & Caswell 2011). Notwithstanding the increased focus on the psychosocial aspects of HIV-discordance, studies have tended to focus on the reproductive decisions of sero-discordant couples (Cook, Hayden, Weiss & Jones 2014; Cooper, Harries, Myer, Orner & Bracken 2007; Cooper, Moodley, Zweigenthal, Bekker, Shah & Myer 2009; Rispel et al. 2011; Withers, Dworkin, Harrington, Kwena, Onono, Bukusi, et al. 2013). There is a dearth of studies on stigma experienced by couples in a sero-discordant relationship . "
"In a recent study, 31% of HIV-infected men and women in care in Uganda reported wanting to have children, yet nearly twothirds had never discussed their fertility desires with a provider . Globally, client conversations with HIV care providers about pregnancy plans are infrequent, as shown in studies from sub-Saharan Africa1617181920, South America [21– 23], North America242526, and Europe . We used qualitative methods to explore healthcare providers' perspectives and current practice regarding reproductive counseling for women and men living with HIV and seeking HIV-related care in southwestern Uganda. "
[Show abstract][Hide abstract]ABSTRACT: We explored healthcare provider perspectives and practices regarding safer conception counseling for HIV-affected clients.
We conducted semistructured interviews with 38 providers (medical and clinical officers, nurses, peer counselors, and village health workers) delivering care to HIV-infected clients across 5 healthcare centres in Mbarara District, Uganda. Interview transcripts were analyzed using content analysis.
Of 38 providers, 76% were women with median age 34 years (range 24–57). First, we discuss providers’ reproductive counseling practices. Emergent themes include that providers (1) assess reproductive goals of HIV-infected female clients frequently, but infrequently for male clients; (2) offer counseling focused on “family planning” and maternal and child health; (3) empathize with the importance of having children for HIV-affected clients; and (4) describe opportunities to counsel HIV-serodiscordant couples. Second, we discuss provider-level challenges that impede safer conception counseling. Emergent themes included the following: (1) providers struggle to translate reproductive rights language into individualized risk reduction given concerns about maternal health and HIV transmission and (2) providers lack safer conception training and support needed to provide counseling.
Tailored guidelines and training are required for providers to implement safer conception counseling. Such support must respond to provider experiences with adverse HIV-related maternal and child outcomes and a national emphasis on pregnancy prevention.
"HIV prevention messaging continues to dominate the reproductive health service landscape for PLHIV, with an emphasis on condom use to prevent HIV transmission and to avoid unintended concep- tion . Support for PLHIV to have children without transmitting HIV to their partners or future children is largely lacking [10,14,15]. Preventing mother to child transmission of HIV (PMTCT) has been an important first step in addressing the risks of vertical transmission associated with childbearing [16,17]. "
[Show abstract][Hide abstract]ABSTRACT: The childbearing needs of people living with HIV (PLHIV) and the experiences of healthcare providers serving them are explored. We examine provider and client knowledge and views on safer conception methods.