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Medeiros P, Koebel J, Yu A, Kazemi M, Nicholson V, Frank P, Persad Y, O'Brien N, Bertozzi B, Smith S, Ndung'u M, Fraleigh A, Gagnier B, Cardinal C, Webster K, Sanchez M, Lee M, Lacombe-Duncan A, Logie CH, Gormley R, de Pokomandy A, Kaida A, Loutfy MR. Experiences and resultant care gaps among women with HIV in Canada: concept mapping the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) findings. BMJ Open 2024; 14:e078833. [PMID: 38569698 PMCID: PMC11146408 DOI: 10.1136/bmjopen-2023-078833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 03/20/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVES The community-based, longitudinal, Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) explored the experiences of women with HIV in Canada over the past decade. CHIWOS' high-impact publications document significant gaps in the provision of healthcare to women with HIV. We used concept mapping to analyse and present a summary of CHIWOS findings on women's experiences navigating these gaps. DESIGN Concept mapping procedures were performed in two steps between June 2019 and March 2021. First, two reviewers (AY and PM) independently reviewed CHIWOS manuscripts and conference abstracts written before 1 August 2019 to identify main themes and generate individual concept maps. Next, the preliminary results were presented to national experts, including women with HIV, to consolidate findings into visuals summarising the experiences and care gaps of women with HIV in CHIWOS. SETTING British Columbia, Ontario and Quebec, Canada. PARTICIPANTS A total of 18 individual CHIWOS team members participated in this study including six lead investigators of CHIWOS and 12 community researchers. RESULTS Overall, a total of 60 peer-reviewed manuscripts and conference abstracts met the inclusion criteria. Using concept mapping, themes were generated and structured through online meetings. In total, six composite concept maps were co-developed: quality of life, HIV care, psychosocial and mental health, sexual health, reproductive health, and trans women's health. Two summary diagrams were created encompassing the concept map themes, one for all women and one specific to trans women with HIV. Through our analysis, resilience, social support, positive healthy actions and women-centred HIV care were highlighted as strengths leading to well-being for women with HIV. CONCLUSIONS Concept mapping resulted in a composite summary of 60 peer-reviewed CHIWOS publications. This activity allows for priority setting to optimise care and well-being for women with HIV.
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Affiliation(s)
- Priscilla Medeiros
- Women's College Hospital, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Jill Koebel
- Women's College Hospital, Toronto, Ontario, Canada
| | - Amy Yu
- Women's College Hospital, Toronto, Ontario, Canada
| | - Mina Kazemi
- Women's College Hospital, Toronto, Ontario, Canada
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Epidemiology and Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Peggy Frank
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Nadia O'Brien
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Mary Ndung'u
- Women's College Hospital, Toronto, Ontario, Canada
| | | | | | - Claudette Cardinal
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Margarite Sanchez
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Melanie Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - A Lacombe-Duncan
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Mona R Loutfy
- Medicine, University of Toronto, Toronto, Ontario, Canada
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Solomon D, Cabecinha M, Gibbs J, Burns F, Sabin CA. How do we measure unmet need within sexual and reproductive health? A systematic review. Perspect Public Health 2024; 144:78-85. [PMID: 36127856 PMCID: PMC10916345 DOI: 10.1177/17579139221118778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Addressing health inequality with sexual and reproductive health requires an understanding of unmet need within a range of populations. This review examined the methods and definitions that have been used to measure unmet need, and the populations most frequently assessed. METHODS Five databases (PubMed, Web of Science, Scopus, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Health Management and Policy Database (HMIC)) were searched for studies that described quantitative measurement of unmet need within sexual and/or reproductive health between 2010 and 2021. A narrative synthesis was then undertaken to ascertain themes within the literature. RESULTS The database search yielded 19,747 papers; 216 papers were included after screening. 190 studies assessed unmet reproductive health need, of which 137 were analyses of trends among people living in low/lower-middle income countries; 181 used cross-sectional data, with only nine analyses being longitudinal. Eighteen studies analysed unmet sexual health need, of which 12 focused on high and upper-middle income populations. 16 papers used cross-sectional analyses. The remaining 10 studies examined unmet need for a combination of sexual and reproductive health services, eight among populations from upper-middle or high income countries. All were cross-sectional analyses. 165 studies used the Demographic and Health Surveys (DHS) definition of unmet need; no other standardised definition was used among the remaining papers. DISCUSSION There is a significant focus on unmet need for contraception among women in low income countries within the published literature, leaving considerable evidence gaps in relation to unmet need within sexual health generally and among men in particular, and unmet reproductive health need in high income settings. In addition, using an increased range of data collection methods, analyses and definitions of unmet need would enable better understanding of health inequality in this area.
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Affiliation(s)
- D Solomon
- Institute for Global Health, University College London, Gower Street, London WC1E 6BT, UK
| | - M Cabecinha
- Institute for Global Health, University College London, London, UK
| | - J Gibbs
- Institute for Global Health, University College London, London, UK
| | - F Burns
- Institute for Global Health, University College London, London, UK; Royal Free London NHS Foundation Trust, London, UK
| | - CA Sabin
- Institute for Global Health, University College London, London, UK
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Skerritt L, Kaida A, Savoie É, Sánchez M, Sarmiento I, O’Brien N, Burchell AN, Bartlett G, Boucoiran I, Kestler M, Rouleau D, Loutfy M, de Pokomandy A. Factors and Priorities Influencing Satisfaction with Care among Women Living with HIV in Canada: A Fuzzy Cognitive Mapping Study. J Pers Med 2022; 12:jpm12071079. [PMID: 35887575 PMCID: PMC9320512 DOI: 10.3390/jpm12071079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
Engagement along the HIV care cascade in Canada is lower among women compared to men. We used Fuzzy Cognitive Mapping (FCM), a participatory research method, to identify factors influencing satisfaction with HIV care, their causal pathways, and relative importance from the perspective of women living with HIV. Building from a map of factors derived from a mixed-studies review of the literature, 23 women living with HIV in Canada elaborated ten categories influencing their satisfaction with HIV care. The most central and influential category was “feeling safe and supported by clinics and healthcare providers”, followed by “accessible and coordinated services” and “healthcare provider expertise”. Participants identified factors that captured gendered social and health considerations not previously specified in the literature. These categories included “healthcare that considers women’s unique care needs and social contexts”, “gynecologic and pregnancy care”, and “family and partners included in care.” The findings contribute to our understanding of how gender shapes care needs and priorities among women living with HIV.
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Affiliation(s)
- Lashanda Skerritt
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (L.S.); (I.S.); (G.B.)
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; (A.K.); (M.S.)
| | - Édénia Savoie
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Margarite Sánchez
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; (A.K.); (M.S.)
- Viva Women, Vancouver, BC V5Z 0C9, Canada
| | - Iván Sarmiento
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (L.S.); (I.S.); (G.B.)
| | - Nadia O’Brien
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 0A9, Canada; (N.O.); (D.R.)
| | - Ann N. Burchell
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada;
| | - Gillian Bartlett
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (L.S.); (I.S.); (G.B.)
- Department of Family and Community Medicine, University of Missouri, Columbia, MO 65211, USA
| | - Isabelle Boucoiran
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC H3T 1C5, Canada;
| | | | - Danielle Rouleau
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 0A9, Canada; (N.O.); (D.R.)
| | - Mona Loutfy
- Women’s College Research Institute, Toronto, ON M5S 1B2, Canada;
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (L.S.); (I.S.); (G.B.)
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
- Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Correspondence: ; Tel.: +1-514-843-2090
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Lacombe-Duncan A, Shokoohi M, Persad Y, Underhill A, Machouf N, Côté P, Wheatley M, Gupta M, Kyne LT, Besharati AA, Fung R, Chan LYL, Arbess G, Bourns A, Nguyen Q, Loutfy M. Short report: Characterizing HIV care among a clinical sample of transgender women living with HIV. HIV Med 2022; 23:324-330. [PMID: 35193172 DOI: 10.1111/hiv.13261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/15/2022] [Accepted: 01/18/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION This study aimed to characterize and identify factors associated with HIV care among transgender (trans) women living with HIV (TWLWH) in two urban centres in Canada. METHODS Retrospective data were collected from clinic charts of TWLWH aged 16 years and older across seven family medicine, endocrinology and/or HIV clinics in Montreal and Toronto, Canada, from 2018 to 2019 (n = 86). We assessed the proportion of individuals being ever engaged in HIV care [defined as having any recorded antiretroviral therapy (ART) regimen and/or viral load], current ART use, and most recent viral load (suppressed [<200 copies/ml] vs. unsuppressed) overall and compared across subgroups using χ2 tests. RESULTS All TWLWH in our sample [100.0%, 95% confidence interval (CI): 95.8-100.0%] were engaged in HIV care; most (93.0%, 95% CI: 85.4-97.4%) were currently using ART and most (93.4%, 95% CI: 85.3-97.8%) with complete data (n = 71/76) were virally suppressed. A higher proportion of trans women of colour (100.0%) reported current ART use compared with white trans women (76.9%, p = 0.017). A higher proportion of those with no documented history of injection drug use (IDU; 96.6%) were virally suppressed compared with those with a history of IDU (66.7%, p = 0.022). Although not statistically significant, 96.2% of those currently reporting feminizing hormone use were virally suppressed, compared with 85.0% of those not reporting use (p = 0.202). CONCLUSIONS Once engaged in HIV care, TWLWH in Canada appear to have excellent ART use and viral suppression. Findings can be leveraged to identify target populations to enhance HIV care and to further explore the relationship between gender-affirming medical care and HIV care.
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Affiliation(s)
- Ashley Lacombe-Duncan
- Women's College Research Institute, Toronto, ON, Canada.,University of Michigan School of Social Work, Ann Arbor, Michigan, USA
| | - Mostafa Shokoohi
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | | | - Nima Machouf
- Clinique de Médecine Urbaine du Quartier Latin, Montreal, QC, Canada
| | - Pierre Côté
- Clinique de Médecine Urbaine du Quartier Latin, Montreal, QC, Canada
| | | | | | - Luke T Kyne
- Women's College Research Institute, Toronto, ON, Canada
| | - Amir A Besharati
- Clinique de Médecine Urbaine du Quartier Latin, Montreal, QC, Canada
| | - Raymond Fung
- Endocrinology, Department of Medicine, Michael Garron Hospital, Toronto, ON, Canada
| | - L Y Louie Chan
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Gordon Arbess
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada
| | - Amy Bourns
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada.,Sherbourne Health, Toronto, ON, Canada
| | - Quang Nguyen
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada.,Sherbourne Health, Toronto, ON, Canada
| | - Mona Loutfy
- Women's College Research Institute, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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Lacombe-Duncan A, Berringer KR, Green J, Jacobs A, Hamdi A. “I do the she and her”: A qualitative exploration of HIV care providers’ considerations of trans women in gender-specific HIV care. WOMEN'S HEALTH 2022; 18:17455057221083809. [PMID: 35311400 PMCID: PMC8935587 DOI: 10.1177/17455057221083809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives: Women of all genders, including cisgender (cis) and transgender (trans) women, experience social and structural drivers of HIV inequities and pervasive barriers to HIV care. Yet, little is known about how HIV care providers address gender diversity in health care. Through a critical feminist lens informed by intersectionality theory, medical anthropology, and critical sociology, we explored (1) how do HIV care providers describe women living with HIV’s care needs and barriers; (2) what are their perspectives on optimal HIV care for women; and (3) to what extent do these conceptualizations include/exclude trans women. Methods: Utilizing a community-based exploratory qualitative study design, we conducted 60–90 minute semi-structured individual interviews from March 2019–April 2020 with eight HIV care providers (n = 4 social service providers; n = 4 physicians) practicing across seven counties representative of rural, suburban, and urban Michigan, United States. Data were analyzed utilizing a reflexive thematic approach. Results: Three overarching themes emerged: (1) Emphasis on (different) clinical needs: key considerations in cis and trans women’s HIV care; (2) Recognition of the structural: barriers to HIV care affecting women of all genders; and (3) Proposed solutions: piecing together individual, social, and organizational interventions to increase access to HIV care that may benefit women living with HIV of all genders but are disproportionately framed as being for cis women. While HIV care providers recognized both cis and trans women living with HIV’s clinical care needs and structural barriers to care, they rarely envisioned optimal HIV care inclusive of gender affirmation and structural interventions. Conclusions: Findings suggest that HIV care providers can avoid reducing gender to biology and making assumptions about reproductive care needs, endocrinological care needs, caregiving responsibilities, and other life circumstances; provide gender-affirming medical care; and address structural barriers to HIV care to enhance intersectional and structurally focused gender-affirming—that is, trans-inclusive—women-centered HIV care.
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Affiliation(s)
| | - Kathryn R Berringer
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
- Department of Anthropology, University of Michigan, Ann Arbor, MI, USA
| | | | - Amy Jacobs
- Michigan HIV/AIDS Treatment Program, Michigan Medicine, Ann Arbor, MI, USA
| | - Amy Hamdi
- Michigan HIV/AIDS Council (MHAC), Lansing, MI, USA
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6
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Cvetkovic A, King E, Skerritt L, Loutfy M, Tseng A, Murray M, van Schalkwyk J, Boucoiran I, Marcotte S, Hankins C, Savoie É, de Pokomandy A, Pick N, Tkachuk S, Rowe T, Smaill F, Walmsley S. A practical clinical guide to counselling on and managing contraception, pre-conception planning, and menopause for women living with HIV. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2021; 6:278-295. [PMID: 36338461 PMCID: PMC9629258 DOI: 10.3138/jammi-2021-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Women represent one quarter of the population living with HIV in Canada and are an increasingly important sector of the HIV community. While some women's health issues such as cervical cancer screening and management are well addressed in HIV management guidelines, others are not. These include sexual and reproductive health factors such as contraception, pre-conception planning, and menopause. Existing literature has shown that while women living with HIV in Canada receive good HIV care based on HIV care cascade indicators, their women's health and sexual and reproductive health care needs are not being met. METHODS In this article, we present a clinical guide for clinicians providing care for women living with HIV on three key women's health topics that are under-discussed during HIV care visits: (1) contraception, (2) pre-conception planning, and (3) menopause. RESULTS We have summarized the most pertinent clinical factors on each topic to support straightforward counselling and present important considerations in the context of HIV-related diseases and treatment. Finally, when relevant, we have provided practical stepwise approaches for addressing each of these women's health care topics when seeing a patient during a visit. CONCLUSIONS It is important that HIV specialists stay well-versed in the complex clinical interactions between HIV treatment and management of women's health issues.
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Affiliation(s)
- Anna Cvetkovic
- Department of Medicine, Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth King
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Lashanda Skerritt
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alice Tseng
- Immunodeficiency Clinic, University Health Network, Toronto, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Murray
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
| | - Julie van Schalkwyk
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynecology, UBC, Vancouver, British Columbia, Canada
| | - Isabelle Boucoiran
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Suzanne Marcotte
- Department of Pharmacy, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - Catherine Hankins
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montréal, Québec, Canada
| | - Édénia Savoie
- McGill University Health Centre, Montréal, Québec, Canada
| | | | - Neora Pick
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
| | - Stacey Tkachuk
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
| | - Timothy Rowe
- Department of Obstetrics and Gynecology, UBC, Vancouver, British Columbia, Canada
| | - Fiona Smaill
- Department of Medicine, Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
| | - Sharon Walmsley
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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7
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Skerritt L, Kaida A, O'Brien N, Burchell AN, Bartlett G, Savoie É, Boucoiran I, Gormley R, Kestler M, Money D, Loutfy M, de Pokomandy A. Patterns of changing pregnancy intentions among women living with HIV in Canada. BMC WOMENS HEALTH 2021; 21:350. [PMID: 34615492 PMCID: PMC8496032 DOI: 10.1186/s12905-021-01492-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/23/2021] [Indexed: 12/01/2022]
Abstract
Background Women with an undetectable viral load can become pregnant and have children with no risk of HIV transmission to their sexual partners and low risk of transmission to their infants. Contemporary pregnancy intentions of women living with HIV in Canada are poorly understood, evidenced by high rates of unintended pregnancy and low uptake of contraceptives. Methods We used longitudinal survey data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) to measure and compare pregnancy intentions (Yes vs No vs Unsure) at baseline, 18-months and 36-months follow-up (from 2013 to 2018) among women living with HIV of reproductive age (16–49 years) and potential. We used Sankey diagrams to depict changes in pregnancy intentions over time and multivariable logistic regression to examine the relationship between pregnancy intention within 2 years and subsequent pregnancy. Results At baseline, 41.9% (119/284) of women intended to become pregnant, 43.3% did not, and 14.8% were unsure. Across 36-months of follow-up, 41.9% (119/284) of women changed their pregnancy intentions, with 25% changing from intending to not intending to become pregnant and 13.1% vice versa. Pregnancy intentions were not strongly associated with subsequent pregnancy between baseline and 18-months (aOR 1.44; 95% CI 0.53, 3.72) or between 18 and 36-months (aOR 2.17; 95% CI 0.92, 5.13). Conclusions Our findings underscore the need for healthcare providers to engage in ongoing discussions with women living with HIV to support their dynamic pregnancy intentions.
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Affiliation(s)
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Nadia O'Brien
- Centre de Recherche du Centre Hospitalier de l'Université de Montreal (CRCHUM), Montreal, Canada
| | - Ann N Burchell
- Department of Family and Community Medicine, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Gillian Bartlett
- Department of Family and Community Medicine, University of Missouri, Columbia, USA
| | - Édénia Savoie
- Chronic Viral Illness Service, McGill University Health Centre, Glen Site 1001 Decarie Blvd., Rm D02.4110, Montreal, QC, H4A 3J1, Canada
| | - Isabelle Boucoiran
- Women and Children's Infectious Diseases Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Mary Kestler
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, Canada.,Faculty of Medicine, University of British Colombia, Vancouver, Canada
| | - Deborah Money
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, Canada.,Faculty of Medicine, University of British Colombia, Vancouver, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, Canada. .,Chronic Viral Illness Service, McGill University Health Centre, Glen Site 1001 Decarie Blvd., Rm D02.4110, Montreal, QC, H4A 3J1, Canada.
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8
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Skerritt L, de Pokomandy A, O'Brien N, Sourial N, Burchell AN, Bartlett G, Schuster T, Rouleau D, Proulx-Boucher K, Pick N, Money D, Gormley R, Carter A, Yudin MH, Loutfy M, Kaida A. Discussing reproductive goals with healthcare providers among women living with HIV in Canada: the role of provider gender and patient comfort. Sex Reprod Health Matters 2021; 29:1932702. [PMID: 34165395 PMCID: PMC8231384 DOI: 10.1080/26410397.2021.1932702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Antiretroviral therapy effectively prevents sexual and vertical transmission of HIV. Yet, some women living with HIV report having unmet needs for reproductive health care. This study measured the prevalence of women discussing reproductive goals with any current healthcare provider and assessed the effect of the current HIV care provider's gender on such discussions and whether comfort was a mediator. We analysed baseline and 18-month survey data from 533 women living with HIV enrolled in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) (2013-2017), a community-based participatory study, restricting the analysis to participants aged 16-45 years. We used causal mediation analysis to estimate direct and indirect effects of the gender of one's HIV care provider on reproductive discussions, incorporating mediating and interaction effects of women having any provider with whom they felt comfortable discussing reproductive goals. Between the baseline and 18-month follow-up surveys, 34.3% (183/533) of women discussed their reproductive goals with a healthcare provider. Having a woman HIV care provider was associated with a 1.18 excess relative risk (ERR) of discussion (95%CI: 0.15, 2.20). The mediating effect of comfort was primarily explained by the fact that those participants with women providers felt more comfortable discussing their reproductive goals compared to participants with men providers, accounting for 66% (95%CI: 32%, 99%) of the total effect. Findings support that HIV provider gender affects women's comfort and whether they discuss reproductive goals, which must be acknowledged and addressed in care delivery.
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Affiliation(s)
- Lashanda Skerritt
- PhD Candidate, Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Alexandra de Pokomandy
- Associate Professor, Department of Family Medicine, McGill University, Montreal QC, Canada; Clinician-Scientist, Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Nadia O'Brien
- PhD Candidate, Department of Family Medicine, McGill University, Montreal, QC, Canada; Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Nadia Sourial
- Assistant Research Professor, Department of Family and Emergency Medicine, University of Montreal, Montreal, QC, Canada
| | - Ann N Burchell
- Associate Professor, Department of Family and Community Medicine and Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Gillian Bartlett
- Professor, Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Tibor Schuster
- Assistant Professor, Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Danielle Rouleau
- Associate Professor, Department of Microbiology, Infection and Immunology, University of Montreal, Montreal, QC, Canada
| | - Karène Proulx-Boucher
- Research Coordinator, Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Neora Pick
- Medical Director, Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada; Clinical Professor, Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Deborah Money
- Professor, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Clinician-Scientist, Women's Health Research Institute, Vancouver, BC, Canada
| | - Rebecca Gormley
- Research Coordinator, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Allison Carter
- Research Fellow, Faculty of Medicine, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mark H Yudin
- Associate Professor, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Mona Loutfy
- Professor, Faculty of Medicine, University of Toronto, Toronto, Canada; Clinician-Scientist, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Angela Kaida
- Associate Professor and Canada Research Chair in Global Perspectives in HIV and Sexual and Reproductive Health, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada. Correspondence:
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