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Kownaklai J, Graham M, Hayter M. Pregnancy decision making among Thai women living with HIV: a grounded theory study: Pregnancy decision making amongst Thai women living with HIV. Midwifery 2022; 115:103490. [PMID: 36155391 DOI: 10.1016/j.midw.2022.103490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE this qualitative research study aims to understand and generate a model of the pregnancy decision-making process in Thai women living with HIV. METHOD the constructivist grounded theory of Charmaz was chosen as the research approach and method to generate a pregnancy decision-making process which is shaped and constructed by personal and social processes. DATA COLLECTION was undertaken in antenatal clinics (ANCs) at two provincial hospitals located in the Northeast of Thailand. In-depth semi-structured interviews were conducted with 15 HIV positive pregnant women. Data analysis involved open coding, making-memos and using the constant comparative method to develop a grounded theory substantive model of HIV pregnancy decision making. FINDINGS the substantive model consists of 6 categories; 1) concealing HIV positive status from partner; 2) desire to have a child; 3) becoming pregnant; 4) keeping or terminating pregnancy; 5) accepting the decision; and 6) adapting to the decision. This research finds that the main concerns women living with HIV have in deciding to have a child are balancing fear, concealing HIV status and the information that they have in each decision making step. Based on the research findings, a unique process of decision making has been found amongst these women that relates to personal and Thai social beliefs. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE the concept illustrates not only the process of decision making but also highlights the main stages, issues and concerns of women living with HIV wanting a child. This study recommends that health care providers need to pay more attention to counselling women and couples living with HIV by giving sufficient contraceptive information to prevent unplanned and unwanted pregnancy, to support and guide the women who want and plan for pregnancy, in advance of this happening, and helping women to deal with HIV disclosure issues related to morality and the rights of couples. Moreover, respect and support must be accorded to HIV positive women about their right to have a child if they choose to do so.
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Affiliation(s)
- Jaruwan Kownaklai
- Department of Maternal-Child Health and Midwifery, Faculty of Nursing, Mahasakham University, Thailand.
| | - Moira Graham
- Co-adviser and Lecturer in Public Health / Graduate Research Director in the School of Health and Social Work, University of Hull, UK.
| | - Mark Hayter
- Principal adviser and Head of Nursing, Manchester Metropolitan University, Manchester, UK.
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Abstract
Although HIV diagnoses among women have declined in recent years in the United States (U.S.), women accounted for 19% of new HIV diagnoses in 2016. In addition, women comprise 24% of the 973,846 persons living with HIV infection in the U.S. However, HIV prevention interventions targeting women are limited. We performed a review on HIV infection in women to increase awareness, improve overall care, and inform intervention development. A systematic literature review was conducted using literature published in PubMed, PsychINFO (EBSCO), and Scopus from July 2000 and June 2017. We included studies that: (1) were conducted in the U.S., (2) enrolled at least 50 HIV-positive women, and (3) utilized a case-control, cohort, or surveillance study design. Of 7497 articles, 48 articles met inclusion criteria. HIV diagnoses among women declined 32% between 2001 and 2016. In 2016, 61% of diagnoses in women were among African American women, and 56% were in the South. Women reported barriers to HIV care largely due to psychosocial challenges and social/structural determinants of health (SDH) barriers. Though new diagnoses among women have declined, racial and regional disparities remain. HIV prevention and research efforts with women are vital to inform interventions and reduce disparities.
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Affiliation(s)
- Symone May
- Public Health Summer Intern Program, Leidos Inc, Atlanta, Georgia.,Emory University Rollins School of Public Health, Atlanta, Georgia.,Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ashley Murray
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Madeline Y Sutton
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Shiferaw T, Kiros G, Birhanu Z, Gebreyesus H, Berhe T, Teweldemedhin M. Fertility desire and associated factors among women on the reproductive age group of Antiretroviral treatment users in Jimma Town, South West Ethiopia. BMC Res Notes 2019; 12:158. [PMID: 30894211 PMCID: PMC6425594 DOI: 10.1186/s13104-019-4190-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 03/13/2019] [Indexed: 12/03/2022] Open
Abstract
Objectives HIV remained the major cause of death in women of reproductive age worldwide. There is limited evidence regarding the fertility desire of HIV positive women receiving HIV care in the study area. Therefore, facility based cross-sectional study was conducted from March to April 2017 to assess fertility desire of HIV positive women and associated factors among mothers in receiving HIV care Jimma town, Southwest Ethiopia. Simple random sampling technique was taken to draw the sample after stratification. Data were analyzed using SPSS version 21 and statistical significance was declared at P value less than 0.05. Results This finding showed that, 175 (46.8%) of the Antiretroviral therapy users had fertility desire with those significantly associated factors; women in the age 18–29 years [AOR = 4.05, 95% CI 1.24–13.33], being married [AOR = 0.32, 95% CI (0.13–0.78)], having diploma educational level [AOR = 5.34, 95% CI 1.10, 15.60], having only boys or girls children [AOR = 2.79, 95% CI (1.24–6.25)], having 18–36$ monthly income [AOR = 1.27, 95% CI (1.56–10.67)], Partner’s HIV status [AOR = 3.56, 95% CI (3.02–9.33)] and non use of contraceptives [AOR = 2.57, 95% CI (1.08–6.13)]. Fertility desire in the study area was high. Strengthening PMTCT service should consider fertility desire of mothers living with HIV. Electronic supplementary material The online version of this article (10.1186/s13104-019-4190-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Teshome Shiferaw
- Department of Health Education and Behavioral Sciences, Jimma University, Jimama, Ethiopia
| | - Getachew Kiros
- Department of Health Education and Behavioral Sciences, Jimma University, Jimama, Ethiopia
| | - Zewdie Birhanu
- Department of Health Education and Behavioral Sciences, Jimma University, Jimama, Ethiopia
| | - Hailay Gebreyesus
- Department of Public Health, College of Health Science, Aksum University, P. O. Box: 298, Aksum, Ethiopia
| | - Tesfay Berhe
- Department of Public Health, College of Health Science, Aksum University, P. O. Box: 298, Aksum, Ethiopia.
| | - Mebrahtu Teweldemedhin
- Department of Medical Laboratory Sciences, College of Health Science, Aksum University, Aksum, Ethiopia
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Nakiganda LJ, Agardh A, Asamoah BO. Cross-sectional study on the prevalence and predictors of pregnancy among women living in HIV discordant relationships in a rural Rakai cohort, Uganda. BMJ Open 2018; 8:e019818. [PMID: 29691244 PMCID: PMC5922486 DOI: 10.1136/bmjopen-2017-019818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study examines the prevalence of pregnancy in serodiscordant couples and identifies predictors associated with pregnancy in rural Rakai, Uganda. STUDY DESIGN A population-based cross-sectional study that used data from the Rakai Community Cohort Study (RCCS). SETTING AND PARTICIPANTS We used data from the RCCS survey round 17 (2015-2016), which included 488 women in serodiscordant relationships. This study was conducted in Rakai district, located in south-western Uganda. PRIMARY OUTCOMES Pregnancy status. STATISTICAL ANALYSIS Multivariable modified Poisson regression using stepwise selection was used to determine characteristics and behaviours associated with pregnancy status. RESULTS The prevalence of pregnancy was 12% in women among serodiscordant couples. HIV-negative women in serodiscordant couples had a slightly higher pregnancy prevalence rate (13.6%) compared with HIV-positive women in serodiscordant couples (11%). Factors significantly associated with higher prevalence of pregnancy were; younger age 15-24 years (prevalence risk ratio (PRR)=4.04; 95% CI 1.72 to 9.50), middle age 25-34 years (PRR=2.49; 95% CI 1.05 to 5.89), Christian religion (PRR=2.26; 95% CI 1.41 to 3.63) and inconsistent condom use in the last 12 months (PRR=4.38, 95% CI 1.09 to 17.53). Neither HIV status nor HIV status disclosure was significantly associated with risk of getting pregnant. CONCLUSION Nearly 12% of women in serodiscordant relationships were pregnant, highlighting the need for integrated services to prevent unintended pregnancies and reduce conceptional related risks for those choosing to conceive. Association with younger age and inconsistent condom use suggests a role for early and continued couple-based conception counselling.
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Affiliation(s)
- Lydia Jacenta Nakiganda
- International Master Programme in Public Health, Faculty of Medicine, Lund University, Lund, Sweden
| | - Anette Agardh
- Social Medicine and Global Health, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Benedict Oppong Asamoah
- Social Medicine and Global Health, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
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Leyva-Moral JM, Palmieri PA, Feijoo-Cid M, Cesario SK, Membrillo-Pillpe NJ, Piscoya-Angeles PN, Goff M, Toledo-Chavarri A, Edwards JE. Reproductive decision-making in women living with human immunodeficiency virus: A systematic review. Int J Nurs Stud 2017; 77:207-221. [PMID: 29112908 DOI: 10.1016/j.ijnurstu.2017.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 10/16/2017] [Accepted: 10/20/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Analyze and synthesize the research evidence to understand the reproductive decisions made by women living with HIV from the beginning of the epidemic to the present. Evaluate the barriers and the facilitators for reproductive decision-making. Identify areas of strength, improvement, and those requiring further research. DESIGN AND DATA SOURCES Systematic review following the PRISMA guideline. PubMed, CINAHL, PsycINFO, Cochrane Library, SocINDEX, Embase, and Scopus databases were searched from 1985 to 2016 using the following Keywords: HIV, AIDS, pregnancy, reproduction, and decision-making. STUDY SELECTION A total of 42 research papers were included in this review. Initially, 1563 papers were identified for the review by database (n=1544) and hand (n=19) searches. With three review levels, 1521 papers were excluded (title review, n=1272; abstract review, n=136; and full paper review, n=113). Studies published in English in peer-reviewed journals using both quantitative and qualitative methods and addressing reproductive decisions in women living with HIV were included. Thirdly, inclusion eligibility was assessed by title, abstract, and full text. REVIEW METHODS Random allocation conducted by the primary researcher assigned an equal number of papers to each researcher for review, including detailed instructions with an abstraction form. Discrepancies were resolved by two researchers. Research quality was assessed using the NCHBL Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, the Critical Appraisal Skills Programme for the qualitative studies and its version for systematic reviews RESULTS: The review included 42 papers, both quantitative (n=24) and qualitative methods (n=14). Most studies were completed by physicians (n=16) or nurses (n=15). More than two-thirds of the studies were performed in urban settings with predominantly African-American women (n=27). Eight factors were identified as influencing the reproductive decision-making process in women living with HIV: 'Socio-demographic, Health status and Pregnancy', 'Religion and spirituality', 'Beliefs and Attitudes about Antiretroviral Therapy', 'Healthcare providers', 'Significant others', 'Motherhood and fulfillment', 'Fear of perinatal infection and infection of partner(s)', 'Birth control and pregnancy management'. CONCLUSIONS Health care providers are not providing patient-centered care by applying scientific evidence to their practice when advising women with HIV in making reproductive decisions. Despite the strong evidence indicating pregnancy for women with HIV results in a safe birthing trajectory, one not likely to jeopardize the health of the either the mother or fetus, providers continue to recommend the women with HIV avoid pregnancy and neglect to invite partners to participate in the discussion.
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Affiliation(s)
- Juan M Leyva-Moral
- Universidad Autónoma de Barcelona, Department of Nursing. Faculty of Medicine. Avda. Can Domenech, Building M. Office M3/211, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.
| | - Patrick A Palmieri
- Facultad de Ciencias de la Salud, Universidad Privada Norbert Wiener. Jr. Larrabure y Unanue 110 Urb. Santa Beatriz, Lima, Perú; College of Graduate Health Studies, A.T. Still University (Mesa, Arizona, USA).
| | - María Feijoo-Cid
- Universidad Autónoma de Barcelona, Department of Nursing. Faculty of Medicine. Avda. Can Domenech, Building M. Office M3/211, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.
| | - Sandra K Cesario
- College of Nursing, Texas Woman's University, 6700 Fannin St., Houston, TX 77030, United States.
| | | | | | - Marilyn Goff
- Texas Woman's University (Houston Campus). 6700 Fannin St., Houston, TX 77030, United States.
| | - Ana Toledo-Chavarri
- Canary Islands Foundation of Health Research and the Center for Biomedical Research of the Canary Islands. Facultad de Medicina - Universidad de La Laguna San Cristobal de La Laguna, Santa Cruz de Tenerife 38071, España.
| | - Joan E Edwards
- College of Nursing, Texas Woman's University, 6700 Fannin St., Houston, TX 77030, United States.
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Burgess A, Purssell E. What is the relationship between increased access to HAART, relationship status and fertility decisions amongst HIV-positive women? A literature review and meta-analysis. J Clin Nurs 2017; 26:3800-3810. [PMID: 28102939 DOI: 10.1111/jocn.13731] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2016] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To investigate the relationship between fertility decisions, to have already had a child or to desire to have one in the future, and the prognostic factors; access to antiretrovirals, the time since these became widely available (year of the study); and relationship status. BACKGROUND There have been significant advances in the treatment of human immunodeficiency virus with the advent of antiretroviral therapy which has been used to successfully reduce the rate of mother to child transmission; leading researchers to hypothesise that human immunodeficiency virus-positive women may desire to have children more so now than in the past. However, this topic is often not discussed in healthcare consultations. DESIGN & METHODS A systematic search was conducted on Cumulative Index of Nursing and Allied Health Literature and Medline, using the key terms 'fertility decisions' and 'human immunodeficiency virus positive'. A meta-analysis of proportions and a meta-regression were conducted using a random-effects model and a logit transformation to normalise the data. Heterogeneity was assessed using Q, I2 and R2 values, and p-values were produced for each regressed variable. RESULTS There was no statistically significant relationship between a desire to have children in the future and any of the prognostic variables. However, there were statistically significant relationships between already having had at least one child; being on antiretroviral therapy; wanting a child in the future; and being in a cohabiting partnership or marriage. CONCLUSION There are no reliable prognostic variables which can be used to predict fertility intentions in human immunodeficiency virus-positive women. There is, however, a significant proportion of women who wish to have children or who have already had children and are in need of reproductive counselling from their healthcare providers. RELEVANCE TO CLINICAL PRACTICE A greater knowledge of factors which may influence reproductive decisions amongst human immunodeficiency virus-positive position will allow healthcare professionals to individualise the care they provide.
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Teixeira LB, Pilecco FB, Vigo Á, Drachler MDL, Leite JCDC, Knauth DR. Factors associated with post-diagnosis pregnancies in women living with HIV in the south of Brazil. PLoS One 2017; 12:e0172514. [PMID: 28222175 PMCID: PMC5319676 DOI: 10.1371/journal.pone.0172514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 02/05/2017] [Indexed: 11/19/2022] Open
Abstract
Objectives To analyze the factors associated with the occurrence of pregnancies after the diagnosis of infection by HIV. Methods Cross-sectional study with women of a reproductive age living with HIV/AIDS cared for in the public services of the city of Porto Alegre, in southern Brazil. The data was analyzed from a comparison between two groups: women with and women without pregnancies after the diagnosis of HIV. Poisson regression models were used to estimate the reasons of prevalence (RP). Results The occurrence of pregnancies after the diagnosis of HIV is associated with a lower level of education (RP adjusted = 1.31; IC95%: 1.03–1.66), non-use of condoms in the first sexual intercourse (RP = 1.32; IC95%: 1.02–1.70), being 20 years old or less when diagnosed with HIV (RP = 3.48; IC95%: 2.02–6.01), and experience of violence related to the diagnosis of HIV (RP = 1.28; IC95%: 1.06–1.56). Conclusions The occurrence of pregnancies after the diagnosis of infection by HIV does not indicate the exercise of the reproductive rights of the women living with HIV/AIDS because these pregnancies occurred in contexts of great vulnerability.
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Affiliation(s)
- Luciana Barcellos Teixeira
- Department of Professional Assistance and Guidance, Nursing School, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Studies Program in Public Health, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
- * E-mail:
| | - Flávia Bulegon Pilecco
- Department of Social Medicine, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
| | - Álvaro Vigo
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
- Department of Statistics, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria de Lourdes Drachler
- Graduate Studies Program in Public Health, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Daniela Riva Knauth
- Department of Social Medicine, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
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Bai D, Leu CS, Mantell JE, Exner TM, Cooper D, Hoffman S, Kelvin EA, Myer L, Constant D, Moodley J. An Approach to Developing a Prediction Model of Fertility Intent Among HIV-Positive Women and Men in Cape Town, South Africa: A Case Study. AIDS Behav 2017; 21:597-609. [PMID: 27294266 DOI: 10.1007/s10461-016-1441-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
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 Africa. Three theoretically-driven prediction models showed reasonable sensitivity (0.70-1.00), specificity (0.66-0.94), and area under the receiver operating characteristic curve (0.79-0.89) for predicting fertility intent at the 6-month visit. A k-fold cross-validation approach was employed to reduce bias due to over-fitting of data in estimating sensitivity, specificity, and area under the curve. We discuss how the methods presented might be used in future studies to develop a clinical screening tool to identify HIV-positive individuals likely to have future fertility intent and who could therefore benefit from sexual and reproductive health counseling around fertility options.
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Affiliation(s)
- Dan Bai
- Department of Biostatistics, Joseph Mailman School of Public Health, Columbia University, New York, NY, USA
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Cheng-Shiun Leu
- Department of Biostatistics, Joseph Mailman School of Public Health, Columbia University, New York, NY, USA
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive Unit 15, New York, NY, USA
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive Unit 15, New York, NY, USA.
| | - Theresa M Exner
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive Unit 15, New York, NY, USA
| | - Diane Cooper
- Women's Health Research Unit, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa
- University of Western Cape School of Public Health, Cape Town, South Africa
| | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive Unit 15, New York, NY, USA
- Department of Epidemiology, Joseph Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Elizabeth A Kelvin
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive Unit 15, New York, NY, USA
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Landon Myer
- Division of Epidemiology and Biostatistics, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa
| | - Debbie Constant
- Women's Health Research Unit, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa
| | - Jennifer Moodley
- Women's Health Research Unit, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Fletcher F, Ingram LA, Kerr J, Buchberg M, Richter DL, Sowell R. "Out of All of this Mess, I Got a Blessing": Perceptions and Experiences of Reproduction and Motherhood in African American Women Living With HIV. J Assoc Nurses AIDS Care 2016; 27:381-91. [PMID: 26781931 PMCID: PMC4903940 DOI: 10.1016/j.jana.2015.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/11/2015] [Indexed: 11/22/2022]
Abstract
HIV disproportionately impacts African American women of childbearing age residing in the southern United States. Antiretroviral therapy has increased the quantity and quality of life for people living with HIV and produced viable and safe reproduction possibilities for women living with HIV. However, little is known about reproductive decision-making processes for African American women living with HIV. The overall goal of our study was to qualitatively explore perspectives related to reproduction and motherhood in HIV-infected African American women of childbearing capacity. HIV-infected African American women of childbearing capacity in South Carolina (N = 42) participated in in-depth interviews. Our respondents held positive views about pregnancy and motherhood, despite nonsupportive pregnancy messages from interpersonal influences, including health care providers. Study findings uncovered the need for programs and interventions to support women's reproductive autonomy and focus on reducing conception- and pregnancy-related transmission risks to infants and uninfected sexual partners.
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Affiliation(s)
- Faith Fletcher
- Assistant Professor, University of Illinois at Chicago School of Public Health, Chicago, Illinois, USA
| | - Lucy Annang Ingram
- Assistant Professor, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Jelani Kerr
- Assistant Professor, University of Louisville School of Public Health & Information Sciences, Louisville, Kentucky, USA
| | - Meredith Buchberg
- Regional Coordinator, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Donna L. Richter
- Distinguished Professor Emeritus, University of South Carolina School of Public Health, Columbia, South Carolina, USA
| | - Richard Sowell
- Professor Nursing, Kennesaw State University Wellstar College of Health & Human Services, Kennesaw, Georgia, USA
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Pregnancy Desire, Partner Serodiscordance, and Partner HIV Disclosure among Reproductive Age HIV-Infected Women in an Urban Clinic. Infect Dis Obstet Gynecol 2016; 2016:8048457. [PMID: 27313441 PMCID: PMC4899585 DOI: 10.1155/2016/8048457] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/04/2016] [Indexed: 11/21/2022] Open
Abstract
Women comprise 25% of the US HIV epidemic, with many women of reproductive age. There is a need for providers to address the reproductive needs and desires of women with HIV given that effective antiretroviral therapy has transformed HIV into a chronic disease. This cross-sectional study shows high rates of partner serodiscordance (61%) and moderate HIV disclosure to partners (61%). Patients surveyed reported practitioners discuss condoms (94%) and contraception (71%) more often than pregnancy desire (38%). In our sample, 44% of the surveyed women intended future pregnancy, whereas women who did not intend future pregnancy cited HIV/health and serodiscordance as the most common reasons (56% and 35%, resp.). There was no difference in the knowledge of mother-to-child transmission risk between women who intended or did not intend future pregnancy (p = 0.71). These results underline the need for provider training in reproductive counseling to promote risk reduction and education.
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Behboodi-Moghadam Z, Khalajinia Z, Nasrabadi ARN, Mohraz M, Gharacheh M. Pregnancy through the Lens of Iranian Women with HIV: A Qualitative Study. J Int Assoc Provid AIDS Care 2015; 15:148-52. [PMID: 26156585 DOI: 10.1177/2325957415593636] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To explore the experience of pregnancy among Iranian women with HIV, 12 HIV-infected pregnant women who referred to counseling center for behavioral diseases in Imam Khomeini Hospital were recruited through purposive sampling. Data were collected by face-to-face, semi-structured interview and were analyzed using conventional content analysis method. Four main themes emerged from the data: fear and hope, stigma and discrimination, marital life stability, and trust in God. Despite concerns about mother-to-child transmission of HIV, and uncertain life span, HIV-infected women tended to continue their pregnancy, and having children was viewed as a window of hope for them.
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Affiliation(s)
- Zahra Behboodi-Moghadam
- Reproductive Health department, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohre Khalajinia
- Reproductive Health department, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Minoo Mohraz
- Iranian Research Center for HIV/AIDS, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Gharacheh
- Reproductive Health department, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Zihlmann KF, Alvarenga ATD. Que desejo é esse? Decisões reprodutivas entre mulheres vivendo com HIV/Aids sob o olhar da psicanálise. SAUDE E SOCIEDADE 2015. [DOI: 10.1590/s0104-12902015000200019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Realizou-se um estudo qualitativo para conhecer como mulheres vivendo com HIV/Aids atribuem sentido às suas decisões reprodutivas, bem como caracterizar seu desejo inconsciente. Foram realizadas entrevistas em profundidade com 15 mulheres adultas, atendidas em um hospital especializado em doenças infecciosas e em uma organização não-governamental. Foi construído um relato sobre a trajetória de vida das entrevistadas com base na técnica da história oral do tipo temática e na perspectiva teórica psicanalítica. Referiu-se aos conceitos de identificação imaginária e identificação simbólica para explicitar aspectos do desejo inconsciente. As falas das entrevistadas mostraram contradições e suas decisões reprodutivas são pautadas por uma lógica inconsciente, sendo que a gravidez, nesse contexto, tem a função de restauração narcísica cujo objetivo é gerar um rebento soronegativo. Outra contradição é que as entrevistadas avaliam as decisões reprodutivas de outras mulheres soropositivas como uma "loucura" ou "irresponsabilidade", enquanto justificam suas próprias decisões procurando se desresponsabilizar por seu desejo inconsciente. Assim, uma contribuição da Psicanálise para o campo da saúde pública é a inclusão das idiossincrasias na relação do sujeito com o outro e, deste modo, viabilizar o resgate da singularidade do desejo inconsciente dos sujeitos, além de permitir uma reflexão sobre a interferência dessas questões no cuidado integral, o que, afinal, pode interferir no acolhimento das necessidades complexas de mulheres vivendo com HIV/Aids.
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Abstract
OBJECTIVE To examine the prevalence of unplanned pregnancies among HIV-infected women in care in the United States. METHODS We used the 2007-2008 cycles of the Medical Monitoring Project, which collected data on HIV-infected adults in care. Women were included if they had an HIV diagnosis before 45 years of age and responded to questions about pregnancies and pregnancy planning after HIV diagnosis. Logistic regression was used to calculate unadjusted and adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for correlates of unplanned pregnancies among women with ≥ 1 pregnancy at or after an HIV diagnosis. RESULTS Of 1492 women, 382 (25.6%) reported ≥ 1 pregnancy after HIV diagnosis (median diagnosis age = 25.0 years; interquartile range = 21.0-30.0); 58% were non-Hispanic black, 22% Hispanic, and 15% non-Hispanic white. Of those, 326 (85.3%) reported ≥ 1 unplanned pregnancy; 124 (32.5%) reported recent unprotected vaginal and/or anal sex with a male partner with either negative or unknown HIV status. Unplanned pregnancies were more likely among women who reported nadir CD4 cell counts <200 cells/μL (AOR = 2.3; 95% CI: 1.2 to 4.8) or did not report nadir CD4 cell counts (AOR = 4.3; 95% CI: 1.9 to 10.5) compared with women who reported nadir CD4 cell counts ≥ 200 cells/μL; and who received public assistance in the most recent year before Medical Monitoring Project interview (AOR = 2.1; 95% CI: 1.1 to 3.8) compared with women who did not receive assistance. CONCLUSIONS Unplanned pregnancies were prevalent among our sample. To avoid unplanned pregnancies, HIV-infected women need access to effective family planning services and risk reduction discussions during routine care visits.
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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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Steiner RJ, Finocchario-Kessler S, Dariotis JK. Engaging HIV care providers in conversations with their reproductive-age patients about fertility desires and intentions: a historical review of the HIV epidemic in the United States. Am J Public Health 2013; 103:1357-66. [PMID: 23763424 DOI: 10.2105/ajph.2013.301265] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Provider-initiated conversations with people living with HIV about reproductive plans are lacking. Providers must know whether their patients want to bear children to tailor treatment and refer for HIV preconception counseling to help achieve patients' reproductive goals while minimizing transmission to partners and children. The early focus on men who have sex with men largely excluded consideration of the epidemic's impact on reproductive health. We used a historical review of the US epidemic to describe the problem's scope and understand if this legacy underlies the current neglect of reproductive planning. Drawing on peer-reviewed literature, we discuss key themes relevant to assessing and understanding attention to desires for children among HIV-positive people. We conclude with recommendations for addressing persistent stigma and enhancing patient-provider communication about reproductive intentions.
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Affiliation(s)
- Riley J Steiner
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Gombachika BT, Sundby J. Pregnancy decisions of married women living with HIV during wide access to antiretroviral therapy in southern Malawi. Health (London) 2013. [DOI: 10.4236/health.2013.512274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Finger JL, Clum GA, Trent ME, Ellen, and the Adolescent Medicine JM. Desire for pregnancy and risk behavior in young HIV-positive women. AIDS Patient Care STDS 2012; 26:173-80. [PMID: 22482121 DOI: 10.1089/apc.2011.0225] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
This cross-sectional study utilized data from 130 young women with behaviorally acquired HIV to examine the association between desire for pregnancy (DFP) and both sociodemographic variables and sexual risk behaviors. A single item was utilized to assess DFP. Bivariate and multivariate regression analyses were conducted. At the bivariate level, DFP was associated with increased rates of intercourse, decreased condom use, increased partner concurrency, increased rates of unprotected sex with a nonconcordant partner, and a higher number of previous sexually transmitted infections (STIs). Multivariate analyses suggested that DFP was associated with increased likelihood of recent intercourse, condom-unprotected sex, and oral sex. DFP was related to few sociodemographic variables but was associated with having fewer children currently, a history of victimization, and decreased rates of disclosure of HIV status. The few sociodemographic variables that were associated with DFP suggest that social relationships may play a role in DFP. DFP was associated with sexual behaviors that may place young women at risk for STI acquisition and secondary HIV transmission to partners. Health care providers should assess DFP in routine HIV care, providing education about fertility options, interventions for vertical transmission, family planning, and risk reduction counseling.
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Affiliation(s)
- Julie L. Finger
- Division of Adolescent Medicine, Department of Pediatrics, Tulane School of Medicine, New Orleans, Louisiana
| | - Gretchen A. Clum
- Department of Community Health Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, Louisiana
| | - Maria E. Trent
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
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De La Cruz NG, Davies SL, Stewart KE. Religion, relationships and reproduction: correlates of desire for a child among mothers living with HIV. AIDS Behav 2011; 15:1233-42. [PMID: 20714924 DOI: 10.1007/s10461-010-9788-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite challenges facing HIV-positive women in the U.S., some maintain strong desires and intentions for motherhood. We explore correlates of desire for another child-particularly current parenting experiences (number of children, parenting efficacy, parenting satisfaction, parenting practices, parental distress, and child-related quality of life), age, spirituality/religiosity, stress, coping, hopelessness, partner's desire for a child, social support, and stigma-among a sample of HIV-positive mothers (n = 96) in Alabama. Partner's desire for a child, participation in private religious practices, avoidant coping, and parity were significantly associated with desire for a child in multivariate models. Such findings indicate a need for reproductive counseling and education that is sensitive to the role of religious norms and values in fertility decision-making and suggest opportunities for partnership with faith-based organizations. Further studies examining the impact of relationship dynamics on childbearing desires among U.S. women living with HIV/AIDS are also needed.
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Affiliation(s)
- Natalie G De La Cruz
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, RPHB 227, 1530 3rd Ave S, Birmingham, AL 35294, USA.
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Finocchario-Kessler S, Sweat MD, Dariotis JK, Anderson JR, Jennings JM, Keller JM, Vyas AA, Trent ME. Childbearing motivations, pregnancy desires, and perceived partner response to a pregnancy among urban female youth: does HIV-infection status make a difference? AIDS Care 2011; 24:1-11. [PMID: 21777077 PMCID: PMC4451594 DOI: 10.1080/09540121.2011.596514] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite a growing literature assessing pregnancy desires among HIV-infected women enrolled in clinical care, little attention has been paid to HIV-infected youth for whom pregnancy is a very relevant issue. In urban areas with high rates of teen pregnancy and HIV infection, further understanding of childbearing motivations and relationship dynamics influencing pregnancy desires among female youth is needed. This study compares the childbearing motivations, pregnancy desires, and perceived partner desire for a pregnancy among predominately African-American HIV-infected (n=46) and HIV-uninfected (n=355) female youth (15-24 years). An HIV-infected status was not significantly associated with childbearing motivations or the desire for a future pregnancy, p>0.10. HIV-infection was, however, associated with an increased likelihood to perceive that one's partner would have a positive response to a pregnancy (adjusted odds ratio [aOR] 3.5, 95% confidence interval [CI] 1.2-10.4, p=0.02) compared to uninfected peers. While race was not associated with participants' own desire for a child, white youth were significantly less likely to perceive a positive partner response to becoming pregnant than their African-American peers (aOR 0.23, 95% CI 0.09-0.56, p=0.001). These data suggest that the desire for childbearing is not diminished by HIV infection among urban female youth, highlighting the need for routine, provider-initiated discussions about childbearing with urban youth to minimized unintended pregnancies and HIV transmission.
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Affiliation(s)
- Sarah Finocchario-Kessler
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Gosselin JT, Sauer MV. Life after HIV: examination of HIV serodiscordant couples' desire to conceive through assisted reproduction. AIDS Behav 2011; 15:469-78. [PMID: 20960049 DOI: 10.1007/s10461-010-9830-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The current study addresses fertility desires and considerations among 143 HIV serodiscordant, opposite-sex couples (in which only the male partner is HIV positive) in the Northeastern U.S. Couples responded to questionnaires during their initial consultation for assisted reproduction, and data were collected over 7 years and analyzed retrospectively. Results indicated that a majority of the male participants had HIV when they met their partner, and a majority also disclosed their HIV status upon meeting. Most couples reported that they had previously discussed or considered a host of fertility-related issues, including the potential risk of HIV infection to the mother and the fetus during the process of fertility treatment. The majority of couples had also discussed the possibility that the male partner could die prematurely due to HIV/AIDS and had considered making arrangements for third-party parenting in the event of the male partner's death. If their fertility treatment were to be successful in the future, most couples desired additional children, and most believed that their future child should be told of the male partner's HIV status. Predictors of the desire for additional children after successful fertility treatment included: younger age, shorter relationship duration, being childless currently, and beginning their relationship after the male partner had already been diagnosed as HIV positive. Future research on fertility desires should include perspectives of HIV positive men on fatherhood, as well as concerns and issues specific to HIV serodiscordant couples.
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Affiliation(s)
- Jennifer T Gosselin
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, College of Physicians and Surgeons, Center for Women's Reproductive Care, Columbia University, 1790 Broadway, New York, NY 10019, USA.
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Kakaire O, Osinde MO, Kaye DK. Factors that predict fertility desires for people living with HIV infection at a support and treatment centre in Kabale, Uganda. Reprod Health 2010; 7:27. [PMID: 20937095 PMCID: PMC2964526 DOI: 10.1186/1742-4755-7-27] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 10/11/2010] [Indexed: 11/10/2022] Open
Abstract
Background Studies from different contexts worldwide indicate that HIV positive patients manifest high-risk sexual behavior characterized by fertility intentions, multiple sexual partners, non-use of contraceptives and non-disclosure of HIV status to their sex partners. The objective was to analyze fertility desires among persons living with HIV at a treatment centre in Kabale Hospital, Southwestern Uganda. Methods From January to August 2009, we interviewed 400 HIV positive patients seeking care using an interviewer-administered questionnaire. We assessed socio-demographic variables, reproductive history, sexuality and fertility desires. At bivariate and multivariate analysis, characteristics of participants who reported or did not report desire to have a child in the near future were compared. Results Of the 400 respondents, (25.3%) were male, 47.3% were aged 25-34 years, over 85% were currently married or had ever been married, and the 62% had primary level of education or less. Over 17% had produced a child since the HIV diagnosis was made, and 28.6% reported that they would like to have a child in the near future. Age of the respondent, being single (versus being ever-married) and whether any of the respondents' children had died were inversely associated with fertility intentions. Conclusion Factors inversely associated with fertility intentions were age of the respondent, marital status and whether any of the respondents' children had died. Use of antiretroviral therapy was not associated with fertility intentions.
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Affiliation(s)
- Othman Kakaire
- Department of Obstetrics and Gynecology, Makerere University Medical School, P,O, Box 7072, Kampala, Uganda.
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Understanding high fertility desires and intentions among a sample of urban women living with HIV in the United States. AIDS Behav 2010; 14:1106-14. [PMID: 19908135 DOI: 10.1007/s10461-009-9637-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To assess childbearing motivations, fertility desires and intentions, and their relationship with key factors, we conducted a cross-sectional survey among 181 HIV-infected women of reproductive age (15-44 years) receiving clinical care at two urban health clinics. Fertility desires (59%) and intentions (66% of those who desired a child) were high among this predominately African American sample of women, while the proportion with accurate knowledge of mother-to-child transmission (MTCT) was low (15%). Multivariate regression analyses identified factors significantly associated with the intention to have a child. Notably, age and parity did not remain significant in the adjusted model. The discrepancies between expressed desires and intentions for future childbearing, and the strong role of perceived partner desire for childbearing emphasize the need for universal reproductive counseling to help women living with HIV navigate their reproductive decisions and facilitate safe pregnancies and healthy children.
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Finocchario-Kessler S, Dariotis JK, Sweat MD, Trent ME, Keller JM, Hafeez Q, Anderson JR. Do HIV-infected women want to discuss reproductive plans with providers, and are those conversations occurring? AIDS Patient Care STDS 2010; 24:317-23. [PMID: 20482467 PMCID: PMC3120085 DOI: 10.1089/apc.2009.0293] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The purpose of the study is to assess frequency and determinants of discussions between HIV-infected women and their HIV providers about childbearing plans, and to identify unmet need for reproductive counseling. We conducted a cross-sectional, audio computer-assisted self-interview (ACASI) among 181 predominately African American HIV-infected women of reproductive age receiving HIV clinical care in two urban health clinics. We used descriptive statistics to identify unmet need for reproductive counseling by determining the proportion of women who want to, but have not, discussed future reproductive plans with their primary HIV care provider. Multivariate analysis determined which factors were associated with general and personalized discussions about pregnancy. Of the 181 women interviewed, 67% reported a general discussion about pregnancy and HIV while 31% reported a personalized discussion about future childbearing plans with their provider. Of the personalized discussions, 64% were patient initiated. Unmet reproductive counseling needs were higher for personalized discussions about future pregnancies (56%) than general discussions about HIV and pregnancy (23%). Younger age was the most powerful determinant of provider communication about pregnancy. A significant proportion of HIV-infected women want to talk about reproductive plans with their HIV provider; however, many have not. HIV care providers and gynecologists can address this unmet communication need by discussing reproductive plans with all women of childbearing age so that preconception counseling can be provided when appropriate. Providers will miss opportunities to help women safely plan pregnancy if they only discuss reproductive plans with younger patients.
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Affiliation(s)
- Sarah Finocchario-Kessler
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
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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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Barnes DB, Murphy S. Reproductive decisions for women with HIV: motherhood's role in envisioning a future. QUALITATIVE HEALTH RESEARCH 2009; 19:481-491. [PMID: 19299754 DOI: 10.1177/1049732309332835] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Cultural influences might exert more influence on HIV-positive women's reproductive choices than HIV-related conditions. In this article we report on grounded theory research on how women with HIV made reproductive decisions during a time of transition from HIV as potentially fatal to mothers and newborns to its current status as an often controllable chronic illness. Eighty HIV-positive women of childbearing age in three United States cities were interviewed, and the interviews were analyzed using grounded theory techniques. The core concept of the findings was that women's decisions were based on their judgment of the relative weight of positive aspects of motherhood versus the often negative pressures of social and public opinion. These findings have relevance for future research as well as for program development and policy.
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Affiliation(s)
- Donna B Barnes
- Women's Studies Program, California State University, East Bay, Hayward, California, USA
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Sanders LB. Sexual behaviors and practices of women living with HIV in relation to pregnancy. J Assoc Nurses AIDS Care 2009; 20:62-8. [PMID: 19118772 DOI: 10.1016/j.jana.2008.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2008] [Accepted: 08/06/2008] [Indexed: 11/18/2022]
Abstract
It has been estimated that 80% of women infected with HIV are of childbearing age. Few data exist to describe the sexual behaviors and practices in relation to pregnancy and childbearing of women living with HIV. This study is a secondary analysis of qualitative data previously gathered to explore the lived experience of pregnancy after diagnosis with HIV. Interviews with a purposive sample of 9 mothers ages 34 to 53 who were previously diagnosed with HIV were tape recorded, transcribed, and analyzed to describe sexual behaviors and practices of women living with HIV in relation to childbearing. The data showed three themes: (a) unprotected sexual relations with the intent to become pregnant, (b) shifting responsibility for condom use as the relationship progressed, and (c) insufficient knowledge of how to reduce partner transmission risk in relation to childbearing. Participants were knowledgeable about the means to minimize transmission to the fetus. Consideration of this information may enhance the provision of health care to minimize transmission risk and encourage the development of further studies about this topic.
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Suryavanshi N, Erande A, Pisal H, Shankar AV, Bhosale RA, Bollinger RC, Phadke M, Sastry J. Repeated pregnancy among women with known HIV status in Pune, India. AIDS Care 2008; 20:1111-8. [PMID: 18608074 DOI: 10.1080/09540120701842753] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
HIV-positive women of reproductive age face challenges in decision making related to pregnancy. Understanding factors influencing repeat pregnancies in women with known HIV status are necessary to guide interventions and counseling strategies to better inform and support them. We compared three groups of women attending a large antenatal clinic in Pune, India. They include: Group A--63 HIV-positive women coming for care for a repeat pregnancy after being diagnosed in a previous pregnancy; Group B--64 HIV-negative (repeat) pregnant women attending this antenatal clinic; and Group C--63 HIV-positive non-pregnant women currently enrolled in an ongoing clinical trial. Comparisons of Group A and B indicate that the likelihood of unplanned repeat pregnancies was significantly higher in HIV-positive (70%) than HIV-negative (36%) women (OR=4.1, CI: 2.0-8.7). Inability to terminate the pregnancy (31%) and familial obligations (40%) appear to be important for continuing the unplanned repeat pregnancy. Despite high reported contraceptive use by HIV-positive women, pregnancies still occurred. Death of their youngest child is an important factor as 21% of HIV-positive pregnant women lost their youngest child compared with 3% of HIV-negative women and 3% of HIV-positive non-pregnant women (p<0.001). Repeat pregnancies were more likely to occur for women who did not disclose their HIV status to their spouse. Thus the majority of the repeat pregnancies for HIV-positive women were both unplanned and unwanted.
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Semprini AE, Hollander LH, Vucetich A, Gilling-Smith C. Infertility Treatment for HIV-Positive Women. WOMENS HEALTH 2008; 4:369-82. [DOI: 10.2217/17455057.4.4.369] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Thanks to antiretroviral combination therapy, HIV-infected individuals live longer, healthier lives and may wish to have children. Women with HIV can attempt to conceive naturally or through simple self-insemination to minimize the risk of horizontal HIV transmission. Assisted reproduction technology is necessary in couples with infertility, which can either be independent of HIV infection and its treatment or be associated with it. This article summarizes the latest evidence regarding the desire for a child in HIV-positive women and how HIV infection and its treatment may impact female fertility. Current data regarding access to and outcomes of assisted conception programs in HIV-positive women wishing to conceive in both high- and low-income countries is also reviewed.
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Affiliation(s)
- Augusto Enrico Semprini
- ESMAN Medical Consulting, Via Carlo Crivelli, 20 20122 Milano, Italy, Tel.: +39 025 843 0703; Fax: +39 025 830 4466
| | - Lital Hannah Hollander
- ESMAN Medical Consulting, Via Carlo Crivelli, 20 20122 Milano, Italy, Tel.: +39 025 843 0703; Fax: +39 025 830 4466
- Tel.: +39 024 549 1134; Fax: +39 024 549 1135
| | - Alessandra Vucetich
- ESMAN Medical Consulting, Via Carlo Crivelli, 20 20122 Milano, Italy, Tel.: +39 025 843 0703; Fax: +39 025 830 4466
- Tel.: +39 025 843 0703; Fax: +39 02 5830 4466
| | - Carole Gilling-Smith
- Chelsea & Westminster Hospital, Assisted Conception Unit, London SW10 9NH, UK, Tel.: +44 172 8746 8000; Fax: +44 172 8746 8921
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Craft SM, Delaney RO, Bautista DT, Serovich JM. Pregnancy decisions among women with HIV. AIDS Behav 2007; 11:927-35. [PMID: 17323122 PMCID: PMC2151976 DOI: 10.1007/s10461-007-9219-6] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Accepted: 01/29/2007] [Indexed: 11/26/2022]
Abstract
Nearly 80% of women currently infected with HIV are of childbearing age. As women of childbearing age continue to be at risk of contracting HIV, there will be an increased need for choices about whether or not to have biological children. The purpose of this exploratory study was to investigate the influence of partners, physicians, and family members on pregnancy decisions, as well as the impact of HIV stigma on these decisions. Results indicated that most women chose not to become pregnant since learning their HIV diagnosis and the woman's age at the time of diagnosis is significantly associated with this decision. Additional factors included fear of transmitting HIV to their child, personal health-related concerns, and desire to have children. Women with a procreative inclination were more likely to choose to become pregnant which outweighed social support and personal health concerns. Implications and suggestions for future research are noted.
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Affiliation(s)
- Shonda M Craft
- Department of Human Development and Family Science, The Ohio State University, 1787 Neil Avenue, Columbus, OH 43210, USA.
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Myer L, Morroni C, Cooper D. Community attitudes towards sexual activity and childbearing by HIV-positive people in South Africa. AIDS Care 2007; 18:772-6. [PMID: 16971287 DOI: 10.1080/09540120500409283] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
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-sectional survey at 26 primary health care clinics in South Africa to investigate community attitudes towards sexual activity and reproduction by HIV-infected individuals. Of the 843 women interviewed, slightly less than half (43%, n = 361) thought that people living with HIV/AIDS should remain sexually active if they choose, while 13% (n = 113) said they thought that people living with HIV/AIDS should have children if they wished to do so. In multivariate analysis, negative attitudes towards both sexuality and childbearing were persistently associated with not knowing someone infected with HIV (p = 0.001 and 0.043, respectively). These findings suggest that the sexual and reproductive health rights of HIV-infected women and men may be an important target as part of efforts to reduce HIV/AIDS-related stigma. Health policies and services are required to reinforce the reproductive rights of HIV-infected individuals in South Africa and other countries in sub-Saharan Africa where HIV is most prevalent.
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Affiliation(s)
- L Myer
- Infectious Diseases Epidemiology Unit, School of Public Health & Family Medicine, University of Cape Town, South Africa.
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Heard I, Sitta R, Lert F. Reproductive choice in men and women living with HIV: evidence from a large representative sample of outpatients attending French hospitals (ANRS-EN12-VESPA Study). AIDS 2007; 21 Suppl 1:S77-82. [PMID: 17159592 DOI: 10.1097/01.aids.0000255089.44297.6f] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In France, the third decade of the HIV epidemic is characterized by a lower age among women who have been recently infected with HIV. This study analysed factors associated with the desire for a child in a sample of heterosexual women and men of reproductive age living with HIV. METHODS Individuals of reproductive age within the VESPA study were included in the analysis. Desire for a child was analysed according to reproductive potential, cultural aspects and HIV-related health condition (CD4 cell count, plasma HIV load and being on treatment). RESULTS A total of 555 women and 699 men who self-identified as heterosexual and did not report a medical diagnosis of infertility, were included in the analysis. Among them, 33% of the women and 20% of the men stated that they expected to have children in the future. In multivariate analysis, significant predictors of the desire for a child included factors associated with reproductive potential (younger age, already being a parent, regular relationship), the HIV status of the regular partner and ethnicity (African origin). HIV-related health status did not affect reproductive intentions among men and women. CONCLUSIONS For both men and women, reproductive potential, ethnicity and partner's HIV status influenced the desire for a child, whereas the person's own clinical condition in relation to HIV had low impact. Reproductive counselling integrated into HIV care should take into account cultural aspects in order to help people living with HIV examine issues of parenthood.
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Affiliation(s)
- Isabelle Heard
- Service d'immunologie Clinique, Hôpital Européen Georges Pompidou, Paris, France.
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Nakayiwa S, Abang B, Packel L, Lifshay J, Purcell DW, King R, Ezati E, Mermin J, Coutinho A, Bunnell R. Desire for children and pregnancy risk behavior among HIV-infected men and women in Uganda. AIDS Behav 2006; 10:S95-104. [PMID: 16715343 DOI: 10.1007/s10461-006-9126-2] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To identify ways to improve prevention of mother-to-child transmission (PMTCT) of HIV, we conducted a cross-sectional study of 1,092 HIV-infected men and women attending an AIDS support organization in Jinja, Uganda, between October 2003 and June 2004. Pregnancy risk behavior was defined as having sex without contraceptive or condom. Overall, 42% of participants were sexually active, 33% practiced pregnancy risk behavior, and 18% desired more children. Men were almost four times to want more children than the women (27% vs. 7%). Among those practicing pregnancy risk behavior, 73% did not want more children and were at high risk for unwanted pregnancies. Although 81% knew that mother-to-child transmission of HIV could be prevented, only 22% believed that an HIV-infected woman who received PMTCT therapy could still deliver an HIV-infected child. Lack of MTCT information, having attended the program for </=2 years and desire for children were independently associated with pregnancy risk behavior. PMTCT and other HIV prevention and care programs should ensure provision of family planning for HIV-infected populations who do not want to become pregnant.
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Affiliation(s)
- Sylvia Nakayiwa
- Centers for Disease Control and Prevention, CDC-Uganda, Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda.
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Hounton SH, Carabin H, Henderson NJ. Towards an understanding of barriers to condom use in rural Benin using the Health Belief Model: a cross sectional survey. BMC Public Health 2005; 5:8. [PMID: 15663784 PMCID: PMC547902 DOI: 10.1186/1471-2458-5-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2004] [Accepted: 01/21/2005] [Indexed: 11/29/2022] Open
Abstract
Background HIV/AIDS is the most dramatic epidemic of the century that has claimed over two decade more than 3 million deaths. Sub Saharan Africa is heavily affected and accounts for nearly 70% of all cases. Despite awareness campaigns, prevention measures and more recently promotion of anti viral regimens, the prevalence of cases and deaths is still rising and the prevalence of systematic condom use remains low, especially in rural areas. This study identifies barriers to condom use based on the Health Belief Model (HBM) in Benin, West Africa. Methods The study was a cross-sectional survey conducted from June to July 2002. Two hundred fifty one (251) individuals were interviewed using a structured questionnaire adapted from a standardized WHO/GAP questionnaire. A logistic regression was used to identify factors associated with condom use. Results In spite of satisfactory knowledge on HIV/AIDS transmission, participants are still at high risk of contracting the infection. Sixty three (63) percents of the interviewees reported being able to recognize infected people, and condom use during the last occasional intercourse was declared by only 36.8% of males and 47.5% of females. Based on the HBM, failure to use condom was related to its perceived lack of efficacy [OR = 9.76 (3.71–30.0)] and perceived quality [OR = 3.61 (1.31–9.91)]. Conclusions This study identifies perceived efficacy (incomplete protective effect) and perceived utilization-related problem (any reported problem using condoms) as the main barriers to condom use. Hence, preventions strategies based on increasing perceived risk, perceived severity or adequate knowledge about HIV/AIDS may not be sufficient to induce condom use. These data will be useful in designing and improving HIV/AIDS prevention outreach programs in Sub Saharan Africa.
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Affiliation(s)
- Sennen H Hounton
- Department of HIV/AIDS and Reproductive Health, Centre MURAZ, Bobo-Dioulasso, Burkina Faso
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Hélène Carabin
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Neil J Henderson
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma, Oklahoma City, Oklahoma, USA
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