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Madeley AM, Earle S, O'Dell L. Challenging norms: Making non-normative choices in childbearing. Results of a meta ethnographic review of the literature. Midwifery 2023; 116:103532. [PMID: 36371862 DOI: 10.1016/j.midw.2022.103532] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/08/2022] [Accepted: 10/28/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Women have the right to make choices during pregnancy and birth that sit outside clinical guidelines, medical recommendations, or normative expectations. Declining recommended place or mode of birth, routine intervention or screening can be considered 'non-normative' within western cultural and social expectations around pregnancy and childbirth. The aim of this review is to establish what is known about the experiences, views, and perceptions of women who make non-normative choices during pregnancy and childbirth to uncover new understandings, conceptualisations, and theories within existing literature. METHODS Using the meta-ethnographic method, and following its seven canonical stages, a systematic search of databases was performed, informed by eMERGe guidelines. FINDINGS Thirty-three studies met the inclusion criteria. Reciprocal translation resulted in three third order constructs - 'influences and motivators', 'barriers and conflict and 'knowledge as empowerment'. Refutational translation resulted in one third order construct - 'the middle ground', which informed the line of argument synthesis and theoretical insights. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The findings of this review suggest that whilst existing literature from a range of high-income countries with similar healthcare systems to the UK have begun to explore non-normative decision-making for discrete episodes of care and choices, knowledge based, theoretical and population gaps exist in relation to understanding the experiences of, and wider social processes involved in, making non-normative choices across the UK maternity care continuum.
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Affiliation(s)
- Anna-Marie Madeley
- Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom.
| | - Sarah Earle
- Graduate School: Research, Enterprise & Scholarship, The Open University, Walton Hall, Milton Keynes MK7 6AA, United Kingdom
| | - Lindsay O'Dell
- School of Nursing and Health Education, University of Bedfordshire, University Square, Luton LU1 3JU, United Kingdom
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Herron LM, Mutch A, Lui CW, Kruizinga L, Howard C, Fitzgerald L. Enduring stigma and precarity: A review of qualitative research examining the experiences of women living with HIV in high income countries over two decades. Health Care Women Int 2021; 43:313-344. [PMID: 34534051 DOI: 10.1080/07399332.2021.1959589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The lived experience of HIV for women remains poorly understood. In particular, there has been little attention to the consequences for women living with HIV (WLHIV) of changing social, epidemiological, biomedical and policy contexts, or to the implications of long-term treatment and aging for the current generation of HIV-positive women. We reviewed qualitative research with WLHIV in selected high-income countries (Australia, Canada, New Zealand, the UK and the USA) to identify the most prevalent experiences of HIV for women and trends over time. Our synthesis highlights the relative consistency of experiences of a diverse sample of WLHIV, particularly the enduring prevalence of gendered HIV-related stigma, sociostructural barriers to healthcare and support, and negative encounters with health professionals. We also identified gaps in knowledge. Understanding women's experiences, particularly their changing needs and strategies for coping as they live long-term with HIV, is key to effective support and services for WLHIV.
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Affiliation(s)
- Lisa-Maree Herron
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Allyson Mutch
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Chi-Wai Lui
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lara Kruizinga
- Queensland Positive People, Brisbane, Queensland, Australia
| | - Chris Howard
- Queensland Positive People, Brisbane, Queensland, Australia
| | - Lisa Fitzgerald
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Tagutanazvo OB, Nolte AGW, Temane A. Experiences of women enrolled in a prevention of mother to child transmission of human immunodeficiency virus infection programme in Zimbabwe. Health SA 2020; 24:1088. [PMID: 31934409 PMCID: PMC6917446 DOI: 10.4102/hsag.v24i0.1088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 08/10/2018] [Indexed: 11/01/2022] Open
Abstract
Background Prevention of mother-to-child transmission (PMTCT) programmes have been reported to reduce the rate of transmission of human immunodeficiency virus (HIV) infection by 30% - 40% during pregnancy and childbirth. The PMTCT transmission is achieved by offering HIV prophylaxis or initiating antiretrovirals to pregnant women who test HIV positive. Being aware of the experiences of these women will assist in planning and implementing the relevant care and support. The study was conducted in three phases. Aim This article will address phase 1 which is to explore and describe the experiences of pregnant women living with HIV. Setting The study setting was a PMTCT site in a Provincial Hospital, in Zimbabwe. Methods The study design was qualitative, exploratory, descriptive and contextual. In-depth face-to-face interviews were conducted from a purposive sample of 20 pregnant women. Thematic data analysis was performed. Results Six themes emerged: realities of disclosure, a need for quality of life, perceived stigmatisation, inadequate knowledge on infant feeding, continuity of care, empowerment and support. Conclusions The study concluded that pregnant women living with HIV require empowerment and support to live positively with HIV.
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Affiliation(s)
| | - Anna G W Nolte
- Department of Nursing, Faculty of Health Sciences, University of Johannesburg, South Africa
| | - Annie Temane
- Department of Nursing, Faculty of Health Sciences, University of Johannesburg, South Africa
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O'Donovan K, Emeto TI. Mother-to-child transmission of HIV in Australia and other high-income countries: Trends in perinatal exposure, demography and uptake of prevention strategies. Aust N Z J Obstet Gynaecol 2018; 58:499-505. [PMID: 29787622 DOI: 10.1111/ajo.12825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 04/08/2018] [Indexed: 11/29/2022]
Abstract
Virtual elimination of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) is a global target. A review of the literature was conducted using medical databases and health department websites to examine the current trends related to perinatal HIV exposure and MTCT in Australia in comparison with other high-income countries (HICs). The review discusses the uptake of prevention strategies and barriers that impede MTCT prevention. The literature suggests an increase in the numbers of HIV-exposed deliveries, but a marked decline in the rates of MTCT within HICs. MTCT remains high when the mother's HIV infection is diagnosed late or postpartum. Data supports increasing trends of perinatal HIV exposure in migrant populations from low- and middle-income countries (particularly African women). Increased uptake and earlier initiation of antiretroviral therapy (ART) was associated with overall MTCT decline. Caesarean section remains the main mode of delivery described; however, the numbers of planned vaginal deliveries are increasing over time. Heterogeneity of data periods and outcome measures within published literature made comparisons between countries difficult. Future development should focus on clear national guidelines and a potential national database for perinatal HIV, culturally appropriate service provision, and more evidence on acute infections in pregnancy and the effects that longer duration and increased uptake of ART has on the fetus and resistance to ART.
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Affiliation(s)
- Kelly O'Donovan
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Theophilus I Emeto
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
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5
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Lytvyn L, Siemieniuk RA, Dilmitis S, Ion A, Chang Y, Bala MM, Manja V, Mirza R, Rodriguez-Gutierrez R, Mir H, El Dib R, Banfield L, Vandvik PO, Bewley S. Values and preferences of women living with HIV who are pregnant, postpartum or considering pregnancy on choice of antiretroviral therapy during pregnancy. BMJ Open 2017; 7:e019023. [PMID: 28893759 PMCID: PMC5988094 DOI: 10.1136/bmjopen-2017-019023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 08/17/2017] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To investigate women's values and preferences regarding antiretroviral therapy (ART) during pregnancy to inform a BMJ Rapid Recommendation. SETTING Primary studies reporting patient-reported outcomes relevant to decision-making regarding ART in any clinical and geographical setting. PARTICIPANTS Women living with HIV who are pregnant, postpartum or considering pregnancy. OUTCOME MEASURES Quantitative measurements and qualitative descriptions of values and preferences in relation to ART during pregnancy. We also included studies on women's reported barriers and facilitators to adherence. We excluded studies correlating objective measures (eg, CD4 count) with adherence, or reporting only outcomes which are not expected to differ between ART alternatives (eg, access to services, knowledge about ART). RESULTS We included 15 qualitative studies reporting values and preferences about ART in the peripartum period; no study directly studied choice of ART therapy during pregnancy. Six themes emerged: a desire to reduce vertical transmission (nine studies), desire for child to be healthy (five studies), concern about side effects to the child (eight studies), desire for oneself to be healthy (five studies), distress about side effect to oneself (10 studies) and pill burden (two studies). None of the studies weighed the relative importance of these outcomes directly, but pill burden/medication complexity appears to be a lower priority for most women compared with other factors. Overall, the body of evidence was at low risk of bias, with minor limitations. CONCLUSIONS Women who are or may become pregnant and who are considering ART appear to place a high value on both their own and their children's health. Evidence on the relative importance between these values when choosing between ART regimens is uncertain. There is variability in individual values and preferences among women. This highlights the importance of an individualised women-centred approach, such as shared decision-making when choosing between ART alternatives. TRIAL REGISTRATION NUMBER International Prospective Register of Systematic Reviews:CRD42017057157.
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Affiliation(s)
- Lyubov Lytvyn
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Reed A Siemieniuk
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Allyson Ion
- School of Social Work, McMaster University, Hamilton, Canada
| | - Yaping Chang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Malgorzata M Bala
- Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Veena Manja
- Department of Medicine, Division of Cardiology, VA Western New York Health Care System, Buffalo, New York, USA
| | - Reza Mirza
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Rene Rodriguez-Gutierrez
- Internal Medicine, University Hospital 'Dr. José E. González', Monterrey, Mexico
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hassan Mir
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Regina El Dib
- Institute of Science and Technology, UNESP—Universidade Estadual Paulista, São José dos Campos, São Paulo, Brazil
| | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, Canada
| | - Per Olav Vandvik
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Medicine, Innlandet Hospital Trust-division, Gjøvik, Norway
| | - Susan Bewley
- Women's Health Academic Centre, King's College London, London, UK
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Li H, Marley G, Ma W, Wei C, Lackey M, Ma Q, Renaud F, Vitoria M, Beanland R, Doherty M, Tucker JD. The Role of ARV Associated Adverse Drug Reactions in Influencing Adherence Among HIV-Infected Individuals: A Systematic Review and Qualitative Meta-Synthesis. AIDS Behav 2017; 21:341-351. [PMID: 27613645 PMCID: PMC5290204 DOI: 10.1007/s10461-016-1545-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Poor adherence remains a major barrier to achieving the clinical and public health benefits of antiretroviral drugs (ARVs). A systematic review and qualitative meta-synthesis was conduct to evaluate how ARV adverse drug reactions may influence ARV adherence. Thirty-nine articles were identified, and 33 reported that ARV adverse drug reactions decreased adherence and six studies found no influence. Visually noticeable adverse drug reactions and psychological adverse reactions were reported as more likely to cause non-adherence compared to other adverse drug reactions. Six studies reported a range of adverse reactions associated with EFV-containing regimens contributing to decreased adherence. Informing HIV-infected individuals about ARV adverse drug reactions prior to initiation, counselling about coping mechanisms, and experiencing the effectiveness of ARVs on wellbeing may improve ARV adherence.
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Affiliation(s)
- Haochu Li
- School of Public Health, Shandong University, Jinan, China.
- UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Gifty Marley
- School of Public Health, Shandong University, Jinan, China
| | - Wei Ma
- School of Public Health, Shandong University, Jinan, China
| | - Chongyi Wei
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Mellanye Lackey
- UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Qingyan Ma
- UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Marco Vitoria
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Rachel Beanland
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Meg Doherty
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Joseph D Tucker
- UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- UNC Project-China, Guangdong Provincial Skin Diseases and STI Control, Number 2 Lujing Road, Guangzhou, 510095, China.
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7
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Mey A, Plummer D, Dukie S, Rogers GD, O'Sullivan M, Domberelli A. Motivations and Barriers to Treatment Uptake and Adherence Among People Living with HIV in Australia: A Mixed-Methods Systematic Review. AIDS Behav 2017; 21:352-385. [PMID: 27826734 DOI: 10.1007/s10461-016-1598-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In Australia, approximately 30% of people diagnosed with HIV are not accessing treatment and 8% of those receiving treatment fail to achieve viral suppression. Barriers limiting effective care warrant further examination. This mixed-methods systematic review accessed health and social sector research databases between November and December 2015 to identify studies that explored the perspective of people living with HIV in Australia. Articles were included for analysis if they described the experiences, knowledge, attitudes and beliefs, in relation to treatment uptake and adherence, published between January 2000 and December 2015. Quality appraisal utilised the Mixed Methods Appraisal Tool Version 2011. Seventy-two studies that met the inclusion criteria were reviewed. The interplay of lack of knowledge, fear, stigma, physical, emotional and social issues were found to negatively impact treatment uptake and adherence. Strategies targeting both the individual and the wider community are needed to address these barriers.
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Affiliation(s)
- Amary Mey
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia.
| | - David Plummer
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Shailendra Dukie
- School of Pharmacy, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Gary D Rogers
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Maree O'Sullivan
- Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Amber Domberelli
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia
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8
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Power J, Lyons A, Brown G, Dowsett GW, Lucke J. Use of antiretroviral treatment among people living with HIV in Australia between 1997 and 2012. AIDS Care 2016; 29:61-66. [PMID: 27327874 DOI: 10.1080/09540121.2016.1198751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Current international targets aim for 90% of people diagnosed with HIV to be on antiretroviral treatment (ART). This paper aims to identify sociodemographic and attitudinal factors associated with ART non-use over time in three samples of Australian people living with HIV (PLHIV). Data for this paper were derived from an Australian cross-sectional survey of PLHIV that was repeated at three different time points: 1997, 2003, and 2012. There were approximately 1000 respondents to each survey (n = 3042 in total). The survey included approximately 250 items related broadly to health and well-being, ART use, and attitudes towards ART use. Univariate and multivariate logistic regression analyses were used. While the proportion of participants using ART increased between 1997 and 2012 (78.8-87.6%, p < .001), there was a decrease between 1997 and 2003 to 70.6% (p < .001). Factors linked to ART non-use remained steady over those 15 years. In all cohorts, people less likely to be using ART were younger and had a more recent diagnosis of HIV. In 2003 and 2012, people in full-time employment were less likely to be using ART, while those whose main source of income was a pension or social security were more likely to be using ART. Multivariate models showed that, at each time point, a belief in the health benefits of delayed ART uptake was associated with non-use. These findings suggest that there may be barriers to ART uptake that have persisted over time despite changes to clinical guidelines that now encourage early uptake.
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Affiliation(s)
- J Power
- a The Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia
| | - A Lyons
- a The Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia
| | - G Brown
- a The Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia
| | - G W Dowsett
- a The Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia
| | - J Lucke
- a The Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia
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9
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Newman CE, Mao L, Persson A, Holt M, Slavin S, Kidd MR, Post JJ, Wright E, de Wit J. 'Not Until I'm Absolutely Half-Dead and Have To:' Accounting for Non-Use of Antiretroviral Therapy in Semi-Structured Interviews with People Living with HIV in Australia. AIDS Patient Care STDS 2015; 29:267-78. [PMID: 25806574 DOI: 10.1089/apc.2014.0301] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Current debates regarding the use of antiretroviral therapy (ART) to promote both individual- and population-level health benefits underscore the importance of understanding why a subpopulation of people with diagnosed HIV and access to treatment choose not to use it. Semi-structured interviews were conducted between 2012 and 2014 with 27 people living with HIV in Australia who were not using ART at the time of interview. Analytic triangulation permitted an appreciation of not only the varied personal reasons for non-use of treatment, but also underlying views on HIV treatment, and the ideal conditions imagined necessary for treatment initiation. Policy goals to increase the number of people with HIV using ART must recognize the diverse explanations for non-use of ART, which include concerns about the various impacts of committing to lifelong pharmaceutical treatment use. Our research identified distinctive subgroups among people who are not using antiretroviral therapy, with a range of individual and social needs that may affect treatment decisions. These findings challenge assumptions about treatment non-use in resource-rich settings, revealing persistent consumer fears about the potent and unknown effects of HIV medications that deserve greater recognition in policy debate on treatment uptake.
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Affiliation(s)
- Christy E. Newman
- Centre for Social Research in Health, UNSW Australia, Sydney, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW Australia, Sydney, Australia
| | - Asha Persson
- Centre for Social Research in Health, UNSW Australia, Sydney, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Australia, Sydney, Australia
| | - Sean Slavin
- Australian Federation of AIDS Organisations, Sydney, Australia
| | - Michael R. Kidd
- Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Jeffrey J. Post
- Department of Infectious Diseases, The Prince of Wales Hospital, Sydney, Australia
- Prince of Wales Clinical School, UNSW Australia, Sydney, Australia
| | - Edwina Wright
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Australia
- The Burnet Institute, Melbourne, Australia
| | - John de Wit
- Centre for Social Research in Health, UNSW Australia, Sydney, Australia
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Hodgson I, Plummer ML, Konopka SN, Colvin CJ, Jonas E, Albertini J, Amzel A, Fogg KP. A systematic review of individual and contextual factors affecting ART initiation, adherence, and retention for HIV-infected pregnant and postpartum women. PLoS One 2014; 9:e111421. [PMID: 25372479 PMCID: PMC4221025 DOI: 10.1371/journal.pone.0111421] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 09/15/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Despite progress reducing maternal mortality, HIV-related maternal deaths remain high, accounting, for example, for up to 24 percent of all pregnancy-related deaths in sub-Saharan Africa. Antiretroviral therapy (ART) is effective in improving outcomes among HIV-infected pregnant and postpartum women, yet rates of initiation, adherence, and retention remain low. This systematic literature review synthesized evidence about individual and contextual factors affecting ART use among HIV-infected pregnant and postpartum women. METHODS Searches were conducted for studies addressing the population (HIV-infected pregnant and postpartum women), intervention (ART), and outcomes of interest (initiation, adherence, and retention). Quantitative and qualitative studies published in English since January 2008 were included. Individual and contextual enablers and barriers to ART use were extracted and organized thematically within a framework of individual, interpersonal, community, and structural categories. RESULTS Thirty-four studies were included in the review. Individual-level factors included both those within and outside a woman's awareness and control (e.g., commitment to child's health or age). Individual-level barriers included poor understanding of HIV, ART, and prevention of mother-to-child transmission, and difficulty managing practical demands of ART. At an interpersonal level, disclosure to a spouse and spousal involvement in treatment were associated with improved initiation, adherence, and retention. Fear of negative consequences was a barrier to disclosure. At a community level, stigma was a major barrier. Key structural barriers and enablers were related to health system use and engagement, including access to services and health worker attitudes. CONCLUSIONS To be successful, programs seeking to expand access to and continued use of ART by integrating maternal health and HIV services must identify and address the relevant barriers and enablers in their own context that are described in this review. Further research on this population, including those who drop out of or never access health services, is needed to inform effective implementation.
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Affiliation(s)
- Ian Hodgson
- Independent Consultant, Bingley, United Kingdom
| | | | - Sarah N. Konopka
- Center for Health Services, Management Sciences for Health, Arlington, Virginia, USA
| | - Christopher J. Colvin
- Centre for Infectious Disease Epidemiology and Research (CIDER), Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Edna Jonas
- Center for Health Services, Management Sciences for Health, Arlington, Virginia, USA
| | - Jennifer Albertini
- United States Agency for International Development (USAID)/Africa Bureau, Washington, D.C., USA
| | - Anouk Amzel
- USAID/Bureau for Global Health (BGH)/Office of HIV/AIDS, Washington, D.C., USA
| | - Karen P. Fogg
- USAID/BGH/Office of Health, Infectious Diseases, and Nutrition, Washington, D.C., USA
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11
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MacCarthy S, Rasanathan JJK, Ferguson L, Gruskin S. The pregnancy decisions of HIV-positive women: the state of knowledge and way forward. REPRODUCTIVE HEALTH MATTERS 2013. [PMID: 23177686 DOI: 10.1016/s0968-8080(12)39641-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Despite the growing number of women living with and affected by HIV, there is still insufficient attention to their pregnancy-related needs, rights, decisions and desires in research, policy and programs. We carried out a review of the literature to ascertain the current state of knowledge and highlight areas requiring further attention. We found that contraceptive options for pregnancy prevention by HIV-positive women are insufficient: condoms are not always available or acceptable, and other options are limited by affordability, availability or efficacy. Further, coerced sterilization of women living with HIV is widely reported. Information gaps persist in relation to effectiveness, safety and best practices regarding assisted reproductive technologies. Attention to neonatal outcomes generally outweighs attention to the health of women before, during and after pregnancy. Access to safe abortion and post-abortion care services, which are critical to women's ability to fulfill their sexual and reproductive rights, are often curtailed. There is inadequate attention to HIV-positive sex workers, injecting drug users and adolescents. The many challenges that women living with HIV encounter in their interactions with sexual and reproductive health services shape their pregnancy decisions. It is critical that HIV-positive women be more involved in the design and implementation of research, policies and programs related to their pregnancy-related needs and rights.
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Affiliation(s)
- Sarah MacCarthy
- The Miriam Hospital and Alpert Medical School of Brown University, Providence, RI, USA.
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12
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Vitalis D. Factors affecting antiretroviral therapy adherence among HIV-positive pregnant and postpartum women: an adapted systematic review. Int J STD AIDS 2013; 24:427-32. [DOI: 10.1177/0956462412472807] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Summary Adherence to antiretroviral therapy (ART) is crucial for effective treatment, but can be quite complex. Non-adherence can adversely affect treatment outcomes. Although many studies have been done on adherence in the general population, few have included HIV-positive pregnant and postpartum women in resource-constrained settings. This review assessed the evidence on adherence among these groups of women. A systematic search of databases was completed between June and July 2011. Both qualitative and quantitative studies were included. Eighteen studies from a total of 6622 satisfied the inclusion criteria that included inter alia facilitators and barriers to adherence. This review highlighted that there is still no consensus on the definition and measurement of adherence; also multiple factors can affect a woman's ability to adhere to ART. Some of the barriers and facilitators identified were similar in both the type of study (qualitative and quantitative) and among the various countries. Findings indicated that the few studies in this population are conducted primarily in resource-rich settings. Such paucity of information warrants urgent attention; thus targeted research is needed to provide insight on adherence within this population.
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Affiliation(s)
- D Vitalis
- Department of Infection and Population Health, Royal Free Hospital & Medical School, University College London, Upper 3rd Floor, Rowland Hill Street, London NW3 2PF, UK
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13
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McDonald K, Amir LH, Davey MA. Maternal bodies and medicines: a commentary on risk and decision-making of pregnant and breastfeeding women and health professionals. BMC Public Health 2011; 11 Suppl 5:S5. [PMID: 22168473 PMCID: PMC3247028 DOI: 10.1186/1471-2458-11-s5-s5] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The perceived risk/benefit balance of prescribed and over-the-counter (OTC) medicine, as well as complementary therapies, will significantly impact on an individual's decision-making to use medicine. For women who are pregnant or breastfeeding, this weighing of risks and benefits becomes immensely more complex because they are considering the effect on two bodies rather than one. Indeed the balance may lie in opposite directions for the mother and baby/fetus. The aim of this paper is to generate a discussion that focuses on the complexity around risk, responsibility and decision-making of medicine use by pregnant and breastfeeding women. We will also consider the competing discourses that pregnant and breastfeeding women encounter when making decisions about medicine. DISCUSSION Women rely not only on biomedical information and the expert knowledge of their health care professionals but on their own experiences and cultural understandings as well. When making decisions about medicines, pregnant and breastfeeding women are influenced by their families, partners and their cultural societal norms and expectations. Pregnant and breastfeeding women are influenced by a number of competing discourses. "Good" mothers should manage and avoid any risks, thereby protecting their babies from harm and put their children's needs before their own - they should not allow toxins to enter the body. On the other hand, "responsible" women take and act on medical advice - they should take the medicine as directed by their health professional. This is the inherent conflict in medicine use for maternal bodies. SUMMARY The increased complexity involved when one body's actions impact the body of another - as in the pregnant and lactating body - has received little acknowledgment. We consider possibilities for future research and methodologies. We argue that considering the complexity of issues for maternal bodies can improve our understanding of risk and public health education.
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Affiliation(s)
- Karalyn McDonald
- Mother & Child Health Research, La Trobe University, 215 Franklin St., Melbourne, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin St., Melbourne, Australia
| | - Lisa H Amir
- Mother & Child Health Research, La Trobe University, 215 Franklin St., Melbourne, Australia
| | - Mary-Ann Davey
- Mother & Child Health Research, La Trobe University, 215 Franklin St., Melbourne, Australia
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McDonald K. 'The old-fashioned way': conception and sex in serodiscordant relationships after ART. CULTURE, HEALTH & SEXUALITY 2011; 13:1119-1133. [PMID: 21916671 DOI: 10.1080/13691058.2011.607242] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This paper explores heterosexual women's accounts of conception and sex within serodiscordant relationships in the period after the advent of Anti-Retroviral Treatment in Australia. It utilises Goffman's theory of stigma and narrative identity theory as a framework for analysis. Six women had planned and conceived pregnancies, four had an unexpected pregnancy and one was attempting to conceive. Accounts of conception usually consisted of a story that involved unprotected sex, once, for the purpose of conceiving. This included what they perceived to be an acceptable risk; one they were willing to take for the desired outcome. Two women gave accounts of artificial insemination. The conception story was usually constructed for the benefit of family and friends aware of the women's status thereby reinforcing the woman's identity as responsible and moral. However, most women revealed their partner did not like condoms and used them sporadically or not at all, directly contradicting the 'conception story'. To justify their actions as informed and responsible, women constructed accounts around low viral load and female-to-male transmission. But a consequence of limited or no condom use was that some women reported worrying about ensuing stigma from their partner's and their families if their partner did seroconvert.
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Affiliation(s)
- Karalyn McDonald
- Australian Research Centre in Sex, Health and Society and Mother & Child Health Research, La Trobe University, Melbourne, Australia.
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