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Pregnancy Intentions and Safer Pregnancy Knowledge Among Female Sex Workers in Port Elizabeth, South Africa. Obstet Gynecol 2017; 128:15-21. [PMID: 27275799 DOI: 10.1097/aog.0000000000001471] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the association between human immunodeficiency virus (HIV) and pregnancy intentions and safer conception knowledge among female sex workers in Port Elizabeth, South Africa. METHODS This cross-sectional study recruited female sex workers in Port Elizabeth using respondent-driven sampling and completed an interviewer-administered questionnaire alongside HIV testing and counseling. In this secondary analysis, robust Poisson regression was used to model prevalence ratios for positive fertility intentions in this cross-sectional study. Knowledge of safer conception methods by HIV status was compared using Fisher exact tests. RESULTS Overall 391 women were represented in the analyses. More than 50% had a prior HIV diagnosis, and an additional 12% were diagnosed with HIV during the study. Approximately half (n=185) of the women reported future pregnancy intentions. In univariate analysis, a prior HIV diagnosis was negatively associated with pregnancy intentions as compared with HIV-negative women (prevalence ratio 0.68, 95% confidence interval 0.55-0.85). Only parity remained independently associated with future pregnancy intentions in multivariate regression after controlling for HIV status, age, race, relationship status, and years selling sex. Knowledge of safer conception methods such as timed sex without a condom, preexposure prophylaxis, or self-insemination was low and similar between those with and without future pregnancy plans. CONCLUSION Pregnancy intentions did not significantly vary according to HIV status. Fertility intentions were high, however, and knowledge of safer conception methods low, suggesting a need to provide female sex workers with advice around options to conceive safely in the context of high HIV prevalence.
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Okoror TA, Falade CO, Walker EM, Olorunlana A, Anaele A. Social context surrounding HIV diagnosis and construction of masculinity: a qualitative study of stigma experiences of heterosexual HIV positive men in southwest Nigeria. BMC Public Health 2016; 16:507. [PMID: 27296862 PMCID: PMC4906588 DOI: 10.1186/s12889-016-3165-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 05/28/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Though research has documented experiences of stigma and its effects on the lives of women living with HIV/AIDS, there is limited research on heterosexual positive HIV men experience of stigma in Nigeria. This study explored how social context surrounding HIV diagnosis impacts stigma experiences of heterosexual HIV positive men and their construction of masculinity in southwest Nigeria. METHODS Using purposive sampling, 17 heterosexual HIV positive men were recruited through community based organization to participate in two hours focus group discussions or 45 min in-depth interviews that were audio-recorded. Without using the word stigma, discussions and interviews were guided by four questions that explored participants' experiences of living with HIV/AIDS. Interviews and discussions were conducted in three languages: English, Yoruba and Pidgin English. Thematic data analysis approach was in coding transcribed data, while social constructivist thinking guided data analysis. RESULTS Participants ranged in age from 30 to 57 years old, and all were receiving antiretroviral therapy. Findings indicated that participants' experiences of stigma might be moderated by the social context surrounding their HIV diagnosis, and whether they have met the socio-cultural construction of masculinity. Participants whose diagnosis were preceded by immediate family members' diagnosis were less likely to report experiencing HIV stigma and more likely to report "not feeling less than a man" and educating others about HIV/AIDS. Contrarily, participants whose diagnosis was preceded by their own sickness were more likely to report isolation, sigma and feeling of being less than a man. All participants reported limiting their sexual intimacy, and those with children reported adjusting how they performed their role as fathers. CONCLUSIONS Social context surrounding HIV diagnosis impact how heterosexual HIV positive men experience HIV related stigma and how they perceive themselves as men, which may influence their care seeking behaviors. These findings have implications for HIV programs geared towards African heterosexual men in general and HIV positive men in particular.
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Affiliation(s)
- Titilayo Ainegbesua Okoror
- Department of Africana Studies, Binghamton University, State University of New York, 4400 Vestal Parkway East, PO Box 6000, Binghamton, NY, 13902-6000, USA.
| | - Catherine Olufunke Falade
- Department of Pharmacology & Therapeutics, College of Medicine, University College Hospital, Univeristy of Ibadan, Queen Elizabeth Road, Private Mail Bag 5017, Ibadan, Oyo, Nigeria
| | - Ebunlomo Mary Walker
- Director, Initiative for Integrated Community Welfare in Nigeria (IICWIN), 8 Alfonso Road, Shasha/Ojoo, Ibadan, Secretariat P.O. Box 29802, Oyo, Nigeria
| | - Adetayo Olorunlana
- Department of Sociology, Faculty of Social Science, University of Ibadan, Ibadan, P.O. Box 0234, Oyo, Nigeria
| | - Agaptus Anaele
- Department of Marketing Communication, Emerson College, 120 Boylston Street, P.O. Box 0234, Boston, MA, 02116-4624, USA
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Kimani J, Warren C, Abuya T, Mutemwa R, Mayhew S, Askew I. Family planning use and fertility desires among women living with HIV in Kenya. BMC Public Health 2015; 15:909. [PMID: 26381120 PMCID: PMC4574729 DOI: 10.1186/s12889-015-2218-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 09/03/2015] [Indexed: 11/12/2022] Open
Abstract
Background Enabling women living with HIV to effectively plan whether and when to become pregnant is an essential right; effective prevention of unintended pregnancies is also critical to reduce maternal morbidity and mortality as well as vertical transmission of HIV. The objective of this study is to examine the use of family planning (FP) services by HIV-positive and HIV-negative women in Kenya and their ability to achieve their fertility desires. Methods Data are derived from a random sample of women seeking family planning services in public health facilities in Kenya who had declared their HIV status (1887 at baseline and 1224 at endline) and who participated in a longitudinal study (the INTEGRA Initiative) that measured the benefits/costs of integrating HIV and sexual/reproductive health services in public health facilities. The dependent variables were FP use in the last 12 months and fertility desires (whether a woman wants more children or not). The key independent variable was HIV status (positive and negative). Descriptive statistics and multivariate logistic regression analysis were used to describe the women’s characteristics and to examine the relationship between FP use, fertility desires and HIV status. Results At baseline, 13 % of the women sampled were HIV-positive. A slightly higher proportion of HIV-positive women were significantly associated with the use of FP in the last 12 months and dual use of FP compared to HIV-negative women. Regardless of HIV status, short-acting contraceptives were the most commonly used FP methods. A higher proportion of HIV-positive women were more likely to be associated with unintended (both mistimed and unwanted) pregnancies and a desire not to have more children. After adjusting for confounding factors, the multivariate results showed that HIV-positive women were significantly more likely to be associated with dual use of FP (OR = 3.2; p < 0.05). Type of health facility, marital status and household wealth status were factors associated with FP use. Factors associated with fertility desires were age, education level and household wealth status. Conclusions The findings highlight important gaps related to utilization of FP among WLHIV. Despite having a greater likelihood of reported use of FP, HIV-positive women were more likely to have had an unintended pregnancy compared to HIV-negative women. This calls for need to strengthen family planning services for WLHIV to ensure they have better access to a wide range of FP methods. There is need to encourage the use of long-acting reversible contraceptive (LARC) to reduce the risk of unintended pregnancy and prevention of vertical transmission of HIV. However, such policies should be based on respect for women’s right to informed reproductive choice in the context of HIV/AIDS. Trial registration NCT01694862
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Affiliation(s)
- James Kimani
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya.
| | - Charlotte Warren
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya.
| | - Timothy Abuya
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya.
| | - Richard Mutemwa
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya.
| | | | - Susannah Mayhew
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK.
| | - Ian Askew
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya.
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Ayoola OD, Victoria GOC, Bamidele O, Olufela KO, Oluwatosin SE, Mbaneifo EP, Titilola G, Adagu AR, Ifeanyi OD, Harry O, Oluwatosin O, Nonyelum ON, Nkiruka D, Chukwujekwu EO. Pattern, challenges and correlates of condom use among Nigerians living with HIV infection. Asian Pac J Trop Biomed 2014; 4:S198-203. [PMID: 25183080 DOI: 10.12980/apjtb.4.2014c1003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 03/13/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To determine the pattern, challenges and correlates of condom use among Nigerians living with HIV Infection. METHODS A cross sectional questionnaire study among HIV positive adults attending an HIV treatment centre in Lagos, Nigeria. Data entry and analysis were done with Epi-info version 3.5.1. RESULTS The mean age of respondents was 35 (SD=7.7; range: 17-58 years) and mean age at sexual debut was 20 years old (range: 7-37 years). Majority were women (66.6%), had at least secondary school education(91.1%), married (68.2%)), on ART (50.7%) and knew their partners HIV status(60.9%). The rate of condom use at last sex act was 65.9%, but only 48.8% used condom consistently. Factors associated with condom use were male gender (OR=2.43, CI=1.35-4.33, P=0.002), less than secondary school education (OR=3.12, CI=1.04-9.28, P=0.05) and Not knowing partner's HIV status (OR=1.90, CI=1.04-3.80, P=0.04). Refusal to use condom (28.4%) were as a result of pregnancy intention, undesirability of condom in marriage and decreased sexual pleasure. CONCLUSION There is low consistent condom use rate of 48.8% among this cohort despite their exposure to behavioural change messages. A review of the present counselling strategy and combination prevention is therefore advocated.
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Affiliation(s)
- Oladele David Ayoola
- Clinical Sciences Division, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | | | - Oke Bamidele
- Clinical Sciences Division, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | | | | | | | - Gbajabiamila Titilola
- Clinical Sciences Division, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Adu Rosemary Adagu
- Clinical Sciences Division, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Onwujekwe Dan Ifeanyi
- Clinical Sciences Division, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Ohwodo Harry
- Clinical Sciences Division, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Odubela Oluwatosin
- Clinical Sciences Division, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | | | - David Nkiruka
- Clinical Sciences Division, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
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Scherer ML, Douglas NC, Churnet BH, Grossman LC, Kline M, Yin MT, Sauer MV, Olender SA. Survey of HIV care providers on management of HIV serodiscordant couples - assessment of attitudes, knowledge, and practices. AIDS Care 2014; 26:1435-9. [PMID: 24878166 DOI: 10.1080/09540121.2014.920950] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Human immunodeficiency virus (HIV) serodiscordant couples are at risk of sexual transmission of HIV between the infected and uninfected partner. We assessed New York area care providers for people living with HIV regarding attitudes, knowledge, and practice patterns toward fertility and conception in serodiscordant couples. Data were collected via a survey distributed in October 2013. Seventeen percent of respondents reported prescribing antiretroviral preexposure prophylaxis (PrEP) for a woman in a serodiscordant couple, and 38% percent of respondents reported having counseled serodiscordant couples on timed, unprotected intercourse without PrEP. Respondents who reported being "very" familiar with the data on HIV transmission in serodiscordant couples were more likely to report counseling their patients in timed, unprotected intercourse compared with those who reported less familiarity with the data (41% vs. 8%, p = 0.001). Although only 20% reported being "very" or "somewhat" familiar with the data on the safety of sperm washing with intrauterine insemination, those who did were more likely to have reported referring a patient for assisted reproductive technology (61% vs. 32%, p = 0.006). Effective patient counseling and referral for appropriate reproductive options were associated with knowledge of the literature pertaining to these options. This emphasizes the need for further provider education on reproductive options and appropriate counseling for serodiscordant couples.
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Affiliation(s)
- Matthew L Scherer
- a Division of Infectious Diseases, Department of Medicine , Columbia Presbyterian Medical Center , New York , NY , USA
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Loutfy MR, Blitz S, Zhang Y, Hart TA, Walmsley SL, Smaill FM, Rachlis AR, Yudin MH, Angel JB, Ralph ED, Tharao W, Raboud JM. Self-Reported Preconception Care of HIV-Positive Women of Reproductive Potential: A Retrospective Study. J Int Assoc Provid AIDS Care 2013; 13:424-33. [PMID: 23918921 DOI: 10.1177/2325957413494238] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES We determined the proportion and correlates of self-reported pregnancy planning discussions (that is preconception counseling) that HIV-positive women reported to their family physicians (FPs), HIV specialists, and obstetrician/gynecologists (OB/Gyns). METHODS In a cross-sectional substudy, HIV-positive women of reproductive potential were asked whether their care providers discussed pregnancy planning. Logistic regression was used to calculate odds ratios for the correlates of preconception counseling. RESULTS A total of 431 eligible participants (median age 38, interquartile range = 32-43) reported having discussion with a physician (92% FP, 96% HIV specialists, and 45% OB/Gyns). In all, 34%, 41%, and 38% had their pregnancy planning discussion with FP, HIV specialist, and Ob/Gyns, respectively; 51% overall. In the multivariable model, significant correlates of preconception counseling were age (P = .02), marital status (P < .01), number of years living in Canada (P < .001), and age of youngest child (P < .01). CONCLUSIONS Preconception care in our cohort was suboptimal. We recommend that counseling on healthy preconception should be part of routine HIV care.
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Affiliation(s)
- Mona R Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Sandra Blitz
- Toronto General Research Institute, Toronto, Ontario, Canada
| | - Yimeng Zhang
- Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Trevor A Hart
- Ryerson University, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Sharon L Walmsley
- Faculty of Medicine, University of Toronto, Ontario, Canada Toronto General Research Institute, Toronto, Ontario, Canada
| | | | - Anita R Rachlis
- Faculty of Medicine, University of Toronto, Ontario, Canada Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark H Yudin
- Faculty of Medicine, University of Toronto, Ontario, Canada St Michael's Hospital, University of Toronto, Ontario, Canada
| | - Jonathan B Angel
- Ottawa Health Research Institute and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Edward D Ralph
- Infectious Diseases Care Program, St Joseph's Health Care, London, Ontario, Canada
| | - Wangari Tharao
- Women's Health in Women's Hands, Toronto, Ontario, Canada
| | - Janet M Raboud
- Toronto General Research Institute, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Ajoge HO, Yende-Zuma N, Jatau ED, Ibrahim S, Olonitola SO, Shittu OS. Community-based intervention is necessary for the control of HIV in North-Central Nigeria. Int J Infect Dis 2012; 17:e234-9. [PMID: 23237969 DOI: 10.1016/j.ijid.2012.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 09/23/2012] [Accepted: 09/26/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To determine factors associated with the observed high prevalence of HIV in North-Central Nigeria. METHODS In a cross-sectional multisite study conducted in 2007, behavioral, medical, and demographic data were obtained from pregnant women (N = 1011) who were tested for the presence of antibody against HIV-1 and HIV-2. RESULTS The overall prevalence of HIV-1 in the 1011 women included in the study was 10.3% (95% confidence interval (CI) 8.4-12.2). In the multivariate analysis, HIV-1 seropositivity was significantly associated with women from the Makurdi (odds ratio (OR) 31.3, 95% CI 3.8-255.7) and Minna (OR 15.4, 95% CI 1.7-135.1) sites in comparison with Panyam site. The presence of tuberculosis (OR 10.7, 95% CI 2.4-48.3) was also significantly associated with HIV-1 seropositive status. Factors associated with HIV-1 also differed between sites. The presence of antibody against HIV-2 was not observed. CONCLUSIONS The high HIV-1 prevalence observed in this study corroborates previous observations in North-Central Nigeria. Disparity in the prevalence across communities was also seen. This is the only detailed socio-epidemiological and behavioral study that has explored potential factors associated with HIV-1 in North-Central Nigeria, and it revealed that differences in risk factors explain the disparity in prevalence across communities.
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Affiliation(s)
- Hannah O Ajoge
- Department of Microbiology, Ahmadu Bello University, Zaria, Nigeria.
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Zhang Y, Margolese S, Yudin MH, Raboud JM, Diong C, Hart TA, Shapiro HM, Librach C, Gysler M, Loutfy MR. Desires, Need, Perceptions, and Knowledge of Assisted Reproductive Technologies of HIV-Positive Women of Reproductive Age in Ontario, Canada. ISRN OBSTETRICS AND GYNECOLOGY 2012; 2012:853503. [PMID: 22957265 PMCID: PMC3431126 DOI: 10.5402/2012/853503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 06/03/2012] [Indexed: 11/23/2022]
Abstract
The purpose of this cross-sectional study is to assess the desire, need, perceptions, and knowledge of assisted reproductive technologies (ARTs) for women living with HIV (WLWHIV) and determine correlates of ART knowledge desire. WLWHIV of reproductive age were surveyed using the survey instrument "The HIV Pregnancy Planning Questionnaire" at HIV/AIDS service organizations across Ontario, Canada. Of our cohort of 500 WLWHIV, median age was 38, 88% were previously pregnant, 78% desired more information regarding ART, 59% were open to the idea of receiving ART, 39% felt they could access a sperm bank, and 17% had difficulties conceiving (self-reported). Age, African ethnicity, and residence in an urban center were correlated with desire for more ART information. Of participants, 50% wanted to speak to an obstetrician/gynecologist regarding pregnancy planning, and 74% regarded physicians as a main source of fertility service information. While the majority of participants in our cohort desire access to ART information, most do not perceive these services as readily accessible. Healthcare practitioners were viewed as main sources of information regarding fertility services and need to provide accurate information regarding access. Fertility service professionals need to be aware of the increasing demand for ART among WLWHIV.
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Affiliation(s)
- Yimeng Zhang
- Women and HIV Research Program, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada M5G 1N6
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada M5S 3K1
| | - Shari Margolese
- Women and HIV Research Program, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada M5G 1N6
| | - Mark H. Yudin
- Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada M5B 1W8
| | - Janet M. Raboud
- Clinical Decision Making and Health Care, University Health Network, Toronto, ON, Canada M5G 2C4
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada M5S 1A1
| | - Christina Diong
- Clinical Decision Making and Health Care, University Health Network, Toronto, ON, Canada M5G 2C4
| | - Trevor A. Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada M5S 1A1
- Department of Psychology, Ryerson University, Toronto, ON, Canada M5B 2K3
| | - Heather M. Shapiro
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada M5G 1X5
| | - Cliff Librach
- Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada M4N 3M5
| | - Matt Gysler
- Department of Obstetrics and Gynecology, Credit Valley Hospital, Mississauga, ON, Canada L5M 2N1
| | - Mona R. Loutfy
- Women and HIV Research Program, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada M5G 1N6
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada M5S 3K1
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Giles ML, Barak S, Baker G, Perna S, Tabrizi S, Greengrass V, Bourne H, Clarke GN, Peak SA, Hoy JF, Foster P, Knight RL. Outcomes from the first assisted reproduction program for HIV-serodiscordant couples in Australia. Med J Aust 2012; 195:599-601. [PMID: 22107010 DOI: 10.5694/mja11.10156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the clinical outcomes for all HIV-serodiscordant couples attending an assisted reproduction program. DESIGN, SETTING AND PARTICIPANTS Retrospective review of demographic, clinical and outcome data for all HIV-serodiscordant couples who attended an assisted reproduction program at a tertiary hospital in Melbourne, between its commencement in 2003 and June 2010. MAIN OUTCOME MEASURES Pregnancies, miscarriages, births, HIV transmission to the HIV-negative partner, semen quality and detection of HIV (HIV RNA and HIV DNA) in semen. RESULTS As of June 2010, 39 HIV-positive clients had proceeded to assisted reproduction after the initial consultation in the program. There were 162 completed cycles, with 26 pregnancies (clinical pregnancy rate per cycle, 16.2% for HIV-positive men with an HIV-negative partner, and 15.4% for HIV-positive women). Of all 222 tested semen samples, 18 (8%) had HIV RNA detected despite these men receiving antiretroviral therapy and having an undetectable HIV viral load in plasma. Sperm velocity was significantly lower in HIV-positive clients receiving combination antiretroviral therapy than in a control group of recipient-recruited sperm donors (P = 0.01); there were no other significant differences in sperm quality between the two groups. No HIV transmission to babies or HIV-negative partners occurred. CONCLUSION Our findings show detectable HIV in 8% of semen samples from men with an undetectable HIV viral load in plasma, but confirm the safety of assisted reproduction for HIV-serodiscordant couples within a program with strict protocols for HIV treatment and testing of all semen before use.
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Brickley DB, Almers L, Kennedy CE, Spaulding AB, Mirjahangir J, Kennedy GE, Packel L, Osborne K, Mbizvo M, Collins L. Sexual and reproductive health services for people living with HIV: a systematic review. AIDS Care 2011; 23:303-14. [PMID: 21347893 DOI: 10.1080/09540121.2010.507746] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
People living with HIV often have unmet needs for sexual and reproductive health (SRH) services. We present results of a systematic review of studies offering SRH services targeted to people living with HIV. Studies were selected from a broader SRH and HIV linkages review. Inclusion criteria included: (1) peer-reviewed journal articles with a pre-post or multiple-arm study design; (2) reported post-intervention evaluation data; and (3) published 1 January 1990 through 31 December 2007. Nine studies were identified with an average rigour score of 5.1 out of 9. Services included family planning (one study), sexually transmitted infection (STI) services (two studies), combined family planning and STI services (three studies) and multiple services (three studies). The review identified mostly positive effects on the outcomes measured, including condom and contraceptive use and quality of services. Yet gaps remain in the research to establish the best approaches for addressing needs and choices of people living with HIV. There is a need for high-quality intervention studies to determine the most successful and cost-effective strategies for providing SRH services to people living with HIV.
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Smee N, Shetty AK, Stranix-Chibanda L, Chirenje M, Chipato T, Maldonado Y, Portillo C. Factors Associated With Repeat Pregnancy Among Women in an Area of High HIV Prevalence in Zimbabwe. Womens Health Issues 2011; 21:222-9. [DOI: 10.1016/j.whi.2010.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Revised: 09/27/2010] [Accepted: 11/10/2010] [Indexed: 11/29/2022]
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Marcellin F, Protopopescu C, Abé C, Boyer S, Blanche J, Ongolo-Zogo P, Koulla-Shiro S, Moatti JP, Carrieri MP, Spire B. Desire for a child among HIV-infected women receiving antiretroviral therapy in Cameroon: results from the national survey EVAL (ANRS 12-116). AIDS Care 2010; 22:441-51. [PMID: 20140791 DOI: 10.1080/09540120903202913] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The majority of HIV-infected people in sub-Saharan Africa are women, many of reproductive age. Cameroon is severely hit by the AIDS epidemic and has developed a large national program for improving access to antiretroviral treatment (ART). The reproductive intentions of women living with HIV/AIDS (WLHA) who obtain access to ART in this country remain poorly documented. Our study aimed at exploring factors associated with the desire to have a child among 1433 ART-treated fertile WLHA aged <50. Analyses were based on data collected during the national cross-sectional survey EVAL (ANRS 12-116), which was conducted between September 2006 and March 2007 in 27 HIV care centers in Cameroon. Logistic regression was used to explore factors associated with women's desire to have a child, defined as reporting the wish to have a/another child. A total of 791 women (55%) reported the desire to have a child. After adjusting for age, matrimonial status, number of biological children, and sexual activity, the main factors independently associated with this desire in a multivariate analysis were having a good physical health-related quality of life (1.02 [1.01-1.03] for a one-point increment on the 12-item Short-Form Health Survey scale) and a CD4 count at ART initiation <200 cells/mm(3) (1.7 [1.2-2.4]). As a conclusion, the desire to have a child is frequent among ART-treated WLHA in Cameroon. HIV care and family planning programs should be integrated more thoroughly in order to support WLHA's reproductive choices.
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Loutfy MR, Hart TA, Mohammed SS, Su D, Ralph ED, Walmsley SL, Soje LC, Muchenje M, Rachlis AR, Smaill FM, Angel JB, Raboud JM, Silverman MS, Tharao WE, Gough K, Yudin MH. Fertility desires and intentions of HIV-positive women of reproductive age in Ontario, Canada: a cross-sectional study. PLoS One 2009; 4:e7925. [PMID: 19997556 PMCID: PMC2785467 DOI: 10.1371/journal.pone.0007925] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Accepted: 10/20/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Improvements in life expectancy and quality of life for HIV-positive women coupled with reduced vertical transmission will likely lead numerous HIV-positive women to consider becoming pregnant. In order to clarify the demand, and aid with appropriate health services planning for this population, our study aims to assess the fertility desires and intentions of HIV-positive women of reproductive age living in Ontario, Canada. METHODOLOGY/PRINCIPAL FINDINGS A cross-sectional study with recruitment stratified to match the geographic distribution of HIV-positive women of reproductive age (18-52) living in Ontario was carried out. Women were recruited from 38 sites between October 2007 and April 2009 and invited to complete a 189-item self-administered survey entitled "The HIV Pregnancy Planning Questionnaire" designed to assess fertility desires, intentions and actions. Logistic regression models were fit to calculate unadjusted and adjusted odds ratios of significant predictors of fertility intentions. The median age of the 490 participating HIV-positive women was 38 (IQR, 32-43) and 61%, 52%, 47% and 74% were born outside of Canada, living in Toronto, of African ethnicity and currently on antiretroviral therapy, respectively. Of total respondents, 69% (95% CI, 64%-73%) desired to give birth and 57% (95% CI, 53%-62%) intended to give birth in the future. In the multivariable model, the significant predictors of fertility intentions were: younger age (age<40) (p<0.0001), African ethnicity (p<0.0001), living in Toronto (p = 0.002), and a lower number of lifetime births (p = 0.02). CONCLUSIONS/SIGNIFICANCE The proportions of HIV-positive women of reproductive age living in Ontario desiring and intending pregnancy were higher than reported in earlier North American studies. Proportions were more similar to those reported from African populations. Healthcare providers and policy makers need to consider increasing services and support for pregnancy planning for HIV-positive women. This may be particularly significant in jurisdictions with high levels of African immigration.
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Affiliation(s)
- Mona R Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
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Nattabi B, Li J, Thompson SC, Orach CG, Earnest J. A systematic review of factors influencing fertility desires and intentions among people living with HIV/AIDS: implications for policy and service delivery. AIDS Behav 2009; 13:949-68. [PMID: 19330443 DOI: 10.1007/s10461-009-9537-y] [Citation(s) in RCA: 192] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 02/23/2009] [Indexed: 11/26/2022]
Abstract
With availability of antiretroviral treatments, HIV is increasingly recognised as a chronic disease people live with for many years. This paper critically reviews the current literature on fertility desires and reproductive intentions among people living with HIV/AIDS (PLHIV) and critiques the theoretical frameworks and methodologies used. A systematic review was conducted using electronic databases: ISI Web of Knowledge, Science Direct, Proquest, Jstor and CINAHL for articles published between 1990 and 2008. The search terms used were fertility desire, pregnancy, HIV, reproductive decision making, reproductive intentions, motherhood, fatherhood and parenthood. Twenty-nine studies were reviewed. Fertility desires were influenced by a myriad of demographic, health, stigma-associated and psychosocial factors. Cultural factors were also important, particularly in Sub-Saharan Africa and Asia. Future research that examines fertility desires among PLHIV should include cultural beliefs and practices in the theoretical framework in order to provide a holistic understanding and to enable development of services that meet the reproductive needs of PLHIV.
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Affiliation(s)
- Barbara Nattabi
- Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, WA, 6845, Australia.
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