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Yan W, Chen X, Xiao D, Wang H, Du X, Li L, Xu C, Song C. Patient mistreatment, social sharing of negative events and emotional exhaustion among Chinese nurses: the combined moderating effect of organizational support and trait resilience. BMC Nurs 2024; 23:260. [PMID: 38649852 PMCID: PMC11036568 DOI: 10.1186/s12912-024-01924-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND As a primary form of work-related violence in the healthcare sector, patient mistreatment negatively impacts nurses' well-being. To date, there has yet reached a definitive conclusion on the mediating mechanism and boundary conditions behind the influence of patient mistreatment on nurses' emotional exhaustion. METHODS This study employed a convenience sampling method to recruit a sample of 1672 nurses from public hospitals in Western China. The data were collected through anonymous self-report questionnaires and analyzed using hierarchical regression and conditional processes to investigate a theoretical framework encompassing patient mistreatment, emotional exhaustion, social sharing of negative events, organizational support, and trait resilience. RESULTS Patient mistreatment led to emotional exhaustion among nurses (β = 0.625, p <.001), and social sharing of negative events mediated this positive relationship (effect = 0.073, SE = 0.013). The combined effects of organizational support and resilience moderated the mediating effect of the social sharing of negative events between patient mistreatment and emotional exhaustion (β=-0.051, p <.05). Specifically, nurses with a high level of resilience would benefit from organizational support to alleviate emotional exhaustion caused by patient mistreatment. CONCLUSIONS This study validated a significant positive association between patient mistreatment and emotional exhaustion, which aligns with previous research findings. Integrating conservation of resources theory and goal progress theory, we addressed previous contradictory findings on the impact of social sharing of negative events on emotional exhaustion. Social sharing of negative events served as a mediator between patient mistreatment and emotional exhaustion. Additionally, the moderating effect of organizational support on the relationship between social sharing of negative events and emotional exhaustion depended on individual trait of resilience.
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Affiliation(s)
- Wei Yan
- School of Economics and Business Administration, Chongqing University, Chongqing, China
| | - Xiu Chen
- School of Economics and Business Administration, Chongqing University, Chongqing, China
| | - Di Xiao
- Medical Insurance Office, Hospital of Chongqing University, Chongqing, China
| | - Huan Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
- Development and Planning Department, Chongqing Medical University, Chongqing, China
| | - Xin Du
- Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Chongqing, China
| | - Li Li
- Human Resources Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chunjuan Xu
- Department of Burn Plastic and Microsurgery, The No. 987 Hospital of Joint Logistic Support Force of PLA, Baoji, China.
| | - Caiping Song
- Xinqiao Hospital, Army Medical University, No. 83 Xinqiao Main Street, Shapingba District, Chongqing, China.
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Schaaf M, Lavelanet A, Codjia L, Nihlén Å, Rehnstrom Loi U. A narrative review of challenges related to healthcare worker rights, roles and responsibilities in the provision of sexual and reproductive services in health facilities. BMJ Glob Health 2023; 8:e012421. [PMID: 37918835 PMCID: PMC10626880 DOI: 10.1136/bmjgh-2023-012421] [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] [Received: 03/28/2023] [Accepted: 10/07/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION This paper identifies and summarises tensions and challenges related to healthcare worker rights and responsibilities and describes how they affect healthcare worker roles in the provision of sexual and reproductive health (SRH) care in health facilities. METHOD The review was undertaken in a two-phase process, namely: (1) development of a list of core constructs and concepts relating to healthcare worker rights, roles and responsibilities to guide the review and (2) literature review. RESULT A total of 110 papers addressing a variety of SRH areas and geographical locations met our inclusion criteria. These papers addressed challenges to healthcare worker rights, roles and responsibilities, including conflicting laws, policies and guidelines; pressure to achieve coverage and quality; violations of the rights and professionalism of healthcare workers, undercutting their ability and motivation to fulfil their responsibilities; inadequate stewardship of the private sector; competing paradigms for decision-making-such as religious beliefs-that are inconsistent with professional responsibilities; donor conditionalities and fragmentation; and, the persistence of embedded practical norms that are at odds with healthcare worker rights and responsibilities. The tensions lead to a host of undesirable outcomes, ranging from professional frustration to the provision of a narrower range of services or of poor-quality services. CONCLUSION Social mores relating to gender and sexuality and other contested domains that relate to social norms, provider religious identity and other deeply held beliefs complicate the terrain for SRH in particular. Despite the particularities of SRH, a whole of systems response may be best suited to address embedded challenges.
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Affiliation(s)
- Marta Schaaf
- Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Antonella Lavelanet
- Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Laurence Codjia
- Department of Health Workforce, World Health Organization, Geneva, Switzerland
| | - Åsa Nihlén
- Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Ulrika Rehnstrom Loi
- Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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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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Gwokyalya V, Beyeza-Kashesya J, Bwanika JB, Matovu JKB, Mugerwa S, Arinaitwe J, Kasozi D, Bukenya J, Kindyomunda R, Wagner GJ, Makumbi FE, Wanyenze RK. Knowledge and correlates of use of safer conception methods among HIV-infected women attending HIV care in Uganda. Reprod Health 2019; 16:64. [PMID: 31138254 PMCID: PMC6538556 DOI: 10.1186/s12978-019-0717-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many people living with HIV would like to have children but family planning (FP) services often focus on only contraception. Availability of safer conception services is still very low in most low income countries. In this study we assessed the knowledge and use of safer conception methods (SCM) among HIV infected women in HIV care in Uganda to inform integration of safer conception in existing FP services. METHODS Data were accrued from a nationally representative cross-sectional survey of 5198 HIV+ women aged 15-49 years from 245 HIV clinics in Uganda. Knowledge and use of safer conception methods and associated factors were determined. The measure of association was prevalence ratio (PR) with corresponding 95% confidence intervals, obtained using a modified Poisson regression via generalized linear models. All the analyses were conducted using STATA version 12.0. RESULTS Overall knowledge of any safer conception method was 74.1% (3852/5198). However only 13.2% knew 3 to 4 methods, 18.9% knew only 2 methods and 42% knew only one method. Knowledge of specific SCM was highest for timed unprotected intercourse (TUI) at 39% (n = 2027) followed by manual self-insemination (MSI) at 34.8% (n = 1809), and pre-exposure prophylaxis (PrEP) at 24.8% (n = 1289). Knowledge of SCM was higher in the Eastern region (84.8%, P < 0.001), among women in HIV-discordant relationships (76.7%, p < 0.017), and those on ART (74.5%, p < 0.034). Overall, 1796 (34.6%) women were pregnant or reported a birth in the past 2 years-overall use of SCM in this group was 11.6% (209/1796). The odds of use of SCM were significantly lower in Kampala [adj. PR = 0.489(0.314, 0.764)] or Eastern region [adj.PR = 0.244; (0.147, 0.405)] compared to Northern region. Higher odds of SCM use were associated with HIV status disclosure to partner [adj.PR = 2.613(1.308, 5.221)] and sero-discordant compared to HIV+ concordant relationship [adj.PR = 1.637(1.236, 2.168)]. Pre-existing knowledge of any one SCM did not influence SCM use. CONCLUSIONS Knowledge and use of SCM among HIV+ women in care is low. Efforts to improve HIV status disclosure, integration of safer conception into FP and HIV services and regional efforts to promote sensitization and access to safer conception can help to increase uptake of safer conception methods.
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Affiliation(s)
| | - Jolly Beyeza-Kashesya
- Department of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda
| | | | | | | | | | - Dickson Kasozi
- Makerere University School of Public Health, Kampala, Uganda
| | - Justine Bukenya
- Makerere University School of Public Health, Kampala, Uganda
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Pottinger AM, Carroll K. Reproductive needs of PLHIV in Jamaica: relationship between fertility desire, motives and depression. J Reprod Infant Psychol 2019; 38:38-48. [PMID: 30939927 DOI: 10.1080/02646838.2019.1599334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background/objective: Advances in antiretroviral therapy and assisted reproduction technology which allow for longer and healthier lives and safer conception options necessitate a new understanding of the sexual and reproductive needs of persons living with HIV (PLHIV). This study examines fertility desire and motives for having children among PLHIV in Jamaica and explores the association with depressive symptoms.Methods: In a cross-sectional study, 251 PLHIV in their reproductive years voluntarily completed an interviewer-administered questionnaire. SPSS analyses involved bivariate and logistic regression models significant at p < .05.Results: A desire to have children was expressed by 66% (n = 166), mostly males and persons younger than 40 years. Of those in a current relationship (n = 126), not having previous children best predicted fertility desire (p = .001; CI 0.04-0.44) as well as motives to conceive (p = .02; CI 0.01-0.66). PLHIVs in their reproductive years who are at depression risk are those in a sero-discordant relationship (p = .01; CI 1.48-30.22) and who have been diagnosed between 1 and 4 years (p = .05; CI 0.01-1.04).Conclusions: HIV status does not dampen the desire to have future children. There is need to evaluate the sexual, reproductive and mental health needs of PLHIV.
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Affiliation(s)
- Audrey M Pottinger
- Faculty of Medical Sciences, The University of the West Indies, Kingston, Jamaica
| | - Kamali Carroll
- The Hugh Wynter Fertility Management Unit, The University of the West Indies, Kingston, Jamaica
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Goggin K, Hurley EA, Wagner GJ, Staggs V, Finocchario-Kessler S, Beyeza-Kashesya J, Mindry D, Birungi J, Wanyenze RK. Changes in Providers' Self-Efficacy and Intentions to Provide Safer Conception Counseling Over 24 Months. AIDS Behav 2018; 22:2895-2905. [PMID: 29464428 DOI: 10.1007/s10461-018-2049-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
High rates of fertility desires, childbearing and serodiscordant partnerships among people living with HIV (PLHIV) in Uganda underscore the need to promote use of safer conception methods (SCM). Effective SCM exist but few PLHIV benefit from provider-led safer conception counseling (SCC) and comprehensive national SCC guidelines are still lacking. Providers' self-efficacy, intentions and attitudes for SCC impact provision and should inform development of services, but there are no longitudinal studies that assess these important constructs. This study reports on changes in providers' knowledge, attitudes, motivation and confidence to provide SCC among a 24-month observational cohort of Ugandan HIV providers. Compared to baseline, providers evidenced increased awareness of SCM, perceived greater value in providing SCC, saw all SCM but sperm washing as likely to be acceptable to clients, reported consistently high interest in and peer support for providing SCC, and perceived fewer barriers at the 24-month follow-up. Providers' intentions for providing SCC stayed consistently high for all SCM except manual self-insemination which decreased at 24 months. Self-efficacy for providing SCC increased from baseline with the greatest improvement in providers' confidence in advising serodiscordant couples where the man is HIV-infected. Providers consistently cite the lack of established guidelines, training, and their own reluctance to broach the issue with clients as significant barriers to providing SCC. Despite providers being more interested and open to providing SCC than ever, integration of SCC into standard HIV services has not happened. Concerted efforts are needed to address remaining barriers by establishing national SCC guidelines and implementing quality provider training.
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Affiliation(s)
- Kathy Goggin
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.
- Schools of Medicine and Pharmacy, University of Missouri - Kansas City, Kansas City, MO, USA.
- Children's Mercy Hospital Kansas City and University of Missouri - Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA.
| | - Emily A Hurley
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| | | | - Vincent Staggs
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
- Schools of Medicine and Pharmacy, University of Missouri - Kansas City, Kansas City, MO, USA
| | | | - Jolly Beyeza-Kashesya
- Department of Obstetrics and Gynaecology, Mulago Hospital, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Deborah Mindry
- Los Angeles Center for Culture and Health, University of California, Los Angeles, CA, USA
| | | | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
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A Systematic Review of the Current Status of Safer Conception Strategies for HIV Affected Heterosexual Couples in Sub-Saharan Africa. AIDS Behav 2018; 22:2916-2946. [PMID: 29869184 DOI: 10.1007/s10461-018-2170-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
We conducted a systematic review of safer conception strategies (SCS) for HIV-affected couples in sub-Saharan Africa to inform evidence-based safer conception interventions. Following PRISMA guidelines, we searched fifteen electronic databases using the following inclusion criteria: SCS research in HIV-affected couples; published after 2007; in sub-Saharan Africa; primary research; peer-reviewed; and addressed a primary topic of interest (SCS availability, feasibility, and acceptability, and/or education and promotion). Researchers independently reviewed each study for eligibility using a standardized tool. We categorize studies by their topic area. We identified 41 studies (26 qualitative and 15 quantitative) that met inclusion criteria. Reviewed SCSs included: antiretroviral therapy (ART), pre-exposure prophylaxis, timed unprotected intercourse, manual/self-insemination, sperm washing, and voluntary male medical circumcision (VMMC). SCS were largely unavailable outside of research settings, except for general availability (i.e., not specifically for safer conception) of ART and VMMC. SCS acceptability was impacted by low client and provider knowledge about safer conception services, stigma around HIV-affected couples wanting children, and difficulty with HIV disclosure in HIV-affected couples. Couples expressed desire to learn more about SCS; however, provider training, patient education, SCS promotions, and integration of reproductive health and HIV services remain limited. Studies of provider training and couple-based education showed improvements in communication around fertility intentions and SCS knowledge. SCS are not yet widely available to HIV-affected African couples. Successful implementation of SCS requires that providers receive training on effective SCS and provide couple-based safer conception counseling to improve disclosure and communication around fertility intentions and reproductive health.
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Goggin K, Hurley EA, Beyeza-Kashesya J, Gwokyalya V, Finocchario-Kessler S, Birungi J, Mindry D, Wanyenze RK, Wagner GJ. Study protocol of "Our Choice": a randomized controlled trial of the integration of safer conception counseling to transform HIV family planning services in Uganda. Implement Sci 2018; 13:110. [PMID: 30107843 PMCID: PMC6092849 DOI: 10.1186/s13012-018-0793-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/10/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND About 40% of HIV-positive women in sub-Saharan Africa become pregnant post-diagnosis. Despite about half of their pregnancies being planned, safer conception methods (SCM) are underutilized among serodiscordant couples, partially due to the fact that safer conception counseling (SCC) has not been integrated into routine HIV family planning (FP) services. METHODS Our Choice is a comprehensive FP intervention that promotes unbiased childbearing consultations to ensure clients receive SCC or contraception services to achieve their desired reproductive goals. The intervention is theoretically grounded and has demonstrated preliminarily feasibility and acceptance through pilot testing. This three-arm cluster randomized controlled trial compares two implementation strategies for integrating Our Choice into routine FP services vs. usual care. Six sites in Uganda will be randomized to receive either (1) Our Choice intervention with enhanced training and supervision provided by study staff (SCC1), (2) Our Choice intervention implemented by the Ministry of Health's standard approach to disseminating new services (SCC2), or (3) existing FP services (usual care). Our Choice and usual care FP services will be implemented simultaneously over a 30-month period. Sixty clients in serodiscordant relationships who express childbearing desires will be enrolled by a study coordinator at each site (n = 360) and followed for 12 months or post-pregnancy (once, if applicable). Analysis will compare intervention arms (SCC1 and SCC2) to usual care and then to each other (SCC1 vs. SCC2) on the primary outcome of correct use of either SCM (if trying to conceive) or dual contraception (if pregnancy is not desired). Secondary outcomes (i.e., pregnancy, use of prevention of mother-to-child transmission services, condom use, and partner seroconversion) and cost-effectiveness will also be examined. DISCUSSION Findings will provide critical information about the success of implementation models of varying intensity for integrating SCC into FP, thereby informing policy and resource allocation within and beyond Uganda. TRIAL REGISTRATION NCT03167879 ClinicalTrials.gov, Registered 30 May, 2017.
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Affiliation(s)
- Kathy Goggin
- Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, MO USA
- Schools of Medicine and Pharmacy, University of Missouri–Kansas City, Kansas City, MO USA
| | - Emily A. Hurley
- Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, MO USA
| | - Jolly Beyeza-Kashesya
- Department of Obstetrics and Gynaecology, Mulago Hospital, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Violet Gwokyalya
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | | | - Josephine Birungi
- The AIDS Support Organization, Kampala, Uganda
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
| | - Deborah Mindry
- Los Angeles Center for Social Medicine and Humanities, University of California, Los Angeles, CA USA
| | - Rhoda K. Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
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Jones DL, Rodriguez VJ, Babayigit S, Chahine A, Weiss SM, Peltzer K. Reproductive decision-making among postpartum HIV-infected women in rural South Africa. Int J STD AIDS 2018; 29:908-916. [PMID: 29629654 DOI: 10.1177/0956462418766932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite pregnancy spacing recommendations to optimize health outcomes among mothers and neonates, unplanned pregnancy in sub-Saharan Africa is common among women living with human immunodeficiency virus (HIV) (WLHIV). This study examined factors associated with reproductive decision-making among WLHIV to inform pregnancy-planning interventions. WLHIV in rural South Africa (n = 165) were assessed at 12 months postpartum. The relative importance of factors associated with reproductive decision-making was estimated. Women were a mean of 28 years old (SD = 5.71). Risk of mother-to-child transmission (MTCT) of HIV (Mean = 0.43; SD = 0.33) had the greatest impact on decision-making, followed by partners' desires (M = 0.22; SD = 0.18), family preferences (M = 0.18; SD = 0.13), and community opinion (M = 0.17; SD = 0.13). MTCT was most important to women with greater HIV knowledge. However, WLHIV who had been diagnosed with HIV for a longer time placed more emphasis on partner preference and community opinion, and less importance on MTCT risk. Prevention of mother-to-child transmission (PMTCT) was less important to women experiencing intimate partner violence and those with depression. Findings highlight the need for tailored, focused interventions to support the unique circumstances of WLHIV and support the inclusion of families and/or partners in the counseling process. Results underscore the need for perinatal preconception counseling for women during routine HIV care.
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Affiliation(s)
- Deborah L Jones
- 1 Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Violeta J Rodriguez
- 1 Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,2 Department of Psychology, University of Georgia, Athens, GA, USA
| | - Suat Babayigit
- 1 Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Antonio Chahine
- 1 Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephen M Weiss
- 1 Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Karl Peltzer
- 3 Human Sciences Research Council, Pretoria, South Africa
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Reproduction and Fertility Beliefs, Perceptions, and Attitudes in People Living with HIV. AIDS Res Treat 2018; 2018:5349793. [PMID: 29805805 PMCID: PMC5899855 DOI: 10.1155/2018/5349793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 02/21/2018] [Indexed: 11/17/2022] Open
Abstract
People living with HIV (PLWH) have distinct needs when it comes to reproductive health, specifically regarding fertility, family planning, and pregnancy, and these needs are often complicated by HIV status. While there is ample research that focuses on reproductive health in PLWH through a quantitative lens, there is a lack of research using qualitative methods, namely, the narrative interview model. We searched PubMed and relevant abstracts to identify 72 articles published from 1997 to 2016 that described a qualitative framework for exploring the behaviors and perceptions regarding family planning, abortion, pregnancy, parenthood, fertility, and forced sterility in PLWH. The inclusion criteria initially showed 147 articles, which were further screened to exclude those that did not address fertility and family planning specifically. Our final sample of articles included articles related to qualitative research on reproductive attitudes, beliefs, and behaviors of PLWH. Several of these articles were mixed-methods analyses, but our focus was on the qualitative portion only. Further qualitative works in this area will not only contribute to gaps quantitative research in the field cannot capture by design, but also inform clinical practice, policy, and interventions through systematic, in-depth evaluation.
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Beyeza-Kashesya J, Wanyenze RK, Goggin K, Finocchario-Kessler S, Woldetsadik MA, Mindry D, Birungi J, Wagner GJ. Stigma gets in my way: Factors affecting client-provider communication regarding childbearing among people living with HIV in Uganda. PLoS One 2018; 13:e0192902. [PMID: 29462171 PMCID: PMC5819785 DOI: 10.1371/journal.pone.0192902] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 02/01/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Many HIV-affected couples living in sub-Saharan Africa desire to have children, but few quantitative studies have examined support for their childbearing needs. Our study explored client-provider communication about childbearing and safer conception among HIV clients in Uganda. METHODS 400 Ugandan HIV clients in committed relationships and with intentions to conceive were surveyed. Knowledge, attitudes and practices related to childbearing, and use of safer conception methods were assessed, including communication with providers about childbearing needs, the correlates of which were examined with bivariate statistics and logistic multivariate analysis. RESULTS 75% of the sample was female; 61% were on antiretroviral therapy; and 61% had HIV-negative or unknown status partners. Nearly all (98%) reported the desire to discuss childbearing intentions with their HIV provider; however, only 44% reported such discussions, the minority (28%) of which was initiated by the provider. Issues discussed with HIV providers included: HIV transmission risk to partner (30%), HIV transmission risk to child (30%), and how to prevent transmission to the child (27%); only 8% discussed safer conception methods. Regression analysis showed that those who had communicated with providers about childbearing were more likely to have been diagnosed with HIV for a longer period [OR (95% CI) = 1.09 (1.03, 1.15)], while greater internalized childbearing stigma was associated with lower odds of this communication [OR (95% CI) = 0.70 (0.49, 0.99)], after controlling for all bivariate correlates and basic demographics. CONCLUSIONS Communication between HIV clients and providers about childbearing needs is poor and associated with stigma. Innovations to mitigate stigma among clients as well as training to improve health worker communication and skills related to safer conception counseling is needed.
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Affiliation(s)
- Jolly Beyeza-Kashesya
- Mulago Hospital Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rhoda K. Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, College of Health Sciences, Kampala, Uganda
| | - Kathy Goggin
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Schools of Medicine and Pharmacy, University of Missouri–Kansas City, Missouri, United States of America
| | - Sarah Finocchario-Kessler
- University of Kansas Medical Center, Department of Family Medicine, Kansas City, Missouri, United States of America
| | | | - Deborah Mindry
- University of California, Los Angeles Center for Culture and Health, Los Angeles, California, United States of America
| | | | - Glenn J. Wagner
- RAND Corporation, Santa Monica, California, United States of America
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Supporting HIV prevention and reproductive goals in an HIV-endemic setting: taking safer conception services from policy to practice in South Africa. J Int AIDS Soc 2017; 20:21271. [PMID: 28361506 PMCID: PMC5577693 DOI: 10.7448/ias.20.2.21271] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction: Safer conception care encompasses HIV care, treatment and prevention for persons living with HIV and their partners who desire children. In 2012, South Africa endorsed a progressive safer conception policy supporting HIV-affected persons to safely meet reproductive goals. However, aside from select research-supported clinics, widespread implementation has not occurred. Using South Africa as a case study, we identify key obstacles to policy implementation and offer recommendations to catalyse expansion of these services throughout South Africa and further afield. Discussion: Four key implementation barriers were identified by combining authors’ safer conception service delivery experiences with available literature. First, strategic implementation frameworks stipulating where, and by whom, safer conception services should be provided are needed. Integrating safer conception services into universal test-and-treat (UTT) and elimination-of-mother-to-child-transmission (eMTCT) priority programmes would support HIV testing, ART initiation and management, viral suppression and early antenatal/eMTCT care engagement goals, reducing horizontal and vertical transmissions. Embedding measurable safer conception targets into these priority programmes would ensure accountability for implementation progress. Second, facing an organizational clinic culture that often undermines clients’ reproductive rights, healthcare providers’ (HCP) positive experiences with eMTCT and enthusiasm for UTT provide opportunities to shift facility-level and individual attitudes in favour of safer conception provision. Third, safer conception guidelines have not been incorporated into HCP training. Combining safer conception with “test-and-treat” training would efficiently ensure that providers are better equipped to discuss clients’ reproductive goals and support safer conception practices. Lastly, HIV-affected couples remain largely unaware of safer conception strategies. HIV-affected populations need to be mobilized to engage with safer conception options alongside other HIV-related healthcare services. Conclusion: Key barriers to widespread safer conception service provision in South Africa include poor translation of policy into practical and measurable implementation plans, inadequate training and limited community engagement. South Africa should leverage the momentum and accountability associated with high priority UTT and eMTCT programmes to reinvigorate implementation efforts by incorporating safer conception into implementation and monitoring frameworks and associated HCP training and community engagement activities. South Africa’s experiences should be used to inform policy development and implementation processes in other HIV high-burden countries.
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Mantell JE, Cooper D, Exner TM, Moodley J, Hoffman S, Myer L, Leu CS, Bai D, Kelvin EA, Jennings K, Stein ZA, Constant D, Zweigenthal V, Cishe N, Nywagi N. Emtonjeni-A Structural Intervention to Integrate Sexual and Reproductive Health into Public Sector HIV Care in Cape Town, South Africa: Results of a Phase II Study. AIDS Behav 2017; 21:905-922. [PMID: 27807792 PMCID: PMC5552040 DOI: 10.1007/s10461-016-1562-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Integration of sexual and reproductive health within HIV care services is a promising strategy for increasing access to family planning and STI services and reducing unwanted pregnancies, perinatal HIV transmission and maternal and infant mortality among people living with HIV and their partners. We conducted a Phase II randomized futility trial of a multi-level intervention to increase adherence to safer sex guidelines among those wishing to avoid pregnancy and adherence to safer conception guidelines among those seeking conception in newly-diagnosed HIV-positive persons in four public-sector HIV clinics in Cape Town. Clinics were pair-matched and the two clinics within each pair were randomized to either a three-session provider-delivered enhanced intervention (EI) (onsite contraceptive services and brief milieu intervention for staff) or standard-of-care (SOC) provider-delivered intervention. The futility analysis showed that we cannot rule out the possibility that the EI intervention has a 10 % point or greater success rate in improving adherence to safer sex/safer conception guidelines than does SOC (p = 0.573), indicating that the intervention holds merit, and a larger-scale confirmatory study showing whether the EI is superior to SOC has merit.
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Affiliation(s)
- J E Mantell
- Division of Gender, Sexuality and Health, Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
| | - D Cooper
- School of Public Health, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - T M Exner
- Division of Gender, Sexuality and Health, Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - J Moodley
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - S Hoffman
- Division of Gender, Sexuality and Health, Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - L Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - C-S Leu
- Division of Gender, Sexuality and Health, Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
- Department of Biostatistics and Epidemiology, Joseph Mailman School of Public Health, Columbia University, New York, NY, USA
| | - D Bai
- Department of Biostatistics and Epidemiology, Joseph Mailman School of Public Health, Columbia University, New York, NY, USA
| | - E A Kelvin
- Division of Gender, Sexuality and Health, Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
- Epidemiology and Biostatistics Department, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - K Jennings
- City of Cape Town Department of Health, Cape Town, South Africa
| | - Z A Stein
- Division of Gender, Sexuality and Health, Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - D Constant
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - V Zweigenthal
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - N Cishe
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - N Nywagi
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
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14
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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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15
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Black V, Davies N, Williams BG, Rees HV, Schwartz SR. Establishing conception intentions and safer conception services for eliminating the vertical, and reducing the horizontal, transmission of HIV. BJOG 2016; 123:1585-8. [PMID: 27305868 DOI: 10.1111/1471-0528.14156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
- V Black
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.,Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - N Davies
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - B G Williams
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - H V Rees
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - S R Schwartz
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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16
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Mayondi GK, Wirth K, Morroni C, Moyo S, Ajibola G, Diseko M, Sakoi M, Magetse JD, Moabi K, Leidner J, Makhema J, Kammerer B, Lockman S. Unintended pregnancy, contraceptive use, and childbearing desires among HIV-infected and HIV-uninfected women in Botswana: across-sectional study. BMC Public Health 2016; 16:44. [PMID: 26774918 PMCID: PMC4715872 DOI: 10.1186/s12889-015-2498-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 11/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background Little is known about the impact of knowledge of HIV serostatus on pregnancy intention and contraceptive use in high-HIV-burden southern African settings in the era of widespread antiretroviral treatment availability. Methods We analyzed interview data collected among 473 HIV-uninfected and 468 HIV-infected pregnant and recently postpartum women at two sites in southern Botswana. Participants were interviewed about their knowledge of their HIV status prior to pregnancy, intendedness of the pregnancy, contraceptive use, and future childbearing desires. Results The median age of the 941 women was 27 years, median lifetime pregnancies was 2, and 416 (44 %) of pregnancies were unintended. Among women reporting unintended pregnancy, 36 % were not using a contraceptive method prior to conception. Among contraception users, 81 % used condoms, 13 % oral contraceptives and 5 % an injectable contraceptive. In univariable analysis, women with unintended pregnancy had a higher number of previous pregnancies (P = <0.0001), were less educated (P = 0.0002), and less likely to be married or living with a partner (P < 0.0001). Thirty-percent reported knowing that they were HIV-infected, 48 % reported knowing they were HIV-uninfected, and 22 % reported not knowing their HIV status prior to conception. In multivariable analysis, women who did not know their HIV status pre-conception were more likely to report their pregnancy as unintended compared to women who knew that they were HIV-uninfected (aOR = 1.7; 95%CI: 1.2-2.5). After controlling for other factors, unintended pregnancy was not associated with knowing one’s HIV positive status prior to conception (compared with knowing one’s negative HIV status prior to conception). Among women with unintended pregnancy, there was no association between knowing their HIV status and contraceptive use prior to pregnancy in adjusted analyses. Sixty-one percent of women reported not wanting any more children after this pregnancy, with HIV-infected women significantly more likely to report not wanting any more children compared to HIV-uninfected women (aOR = 3.9; 95%CI: 2.6-5.8). Conclusions The high rates of reported unintended pregnancy and contraceptive failure/misuse underscore an urgent need for better access to effective contraceptive methods for HIV-uninfected and HIV -infected women in Botswana. Lower socioeconomic status and lack of pre-conception HIV testing may indicate higher risk for unintended pregnancy in this setting.
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Affiliation(s)
- Gloria K Mayondi
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana.
| | | | - Chelsea Morroni
- EGA Institute for Women's Health/Institute for Global Health, University College London, 74 Huntley Street, WC1E 6AU, London, UK. .,University of Botswana, Department of Public Health Medicine, University of Botswana Main Campus, Block 246, Gaborone, Botswana. .,Botswana-UPenn Partnership, University of Botswana Main Campus, 244G, Gaborone, Botswana.
| | - Sikhulile Moyo
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana.
| | - Gbolahan Ajibola
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana.
| | - Modiegi Diseko
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana.
| | - Maureen Sakoi
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana.
| | - Jane Dipuo Magetse
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana.
| | - Kebaiphe Moabi
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana.
| | - Jean Leidner
- Goodtables Data Consulting, 3101 Tisbury Rd., Norman, 73071, OK, USA.
| | - Joseph Makhema
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. .,Harvard School of Public Health, Boston, MA, USA.
| | - Betsy Kammerer
- Boston Children's Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Shahin Lockman
- Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. .,Harvard School of Public Health, Boston, MA, USA. .,Brigham and Women's Hospital, 15 Francis Street, PBB 4A, Boston, 02115, MA, USA.
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17
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Narasimhan M, Loutfy M, Khosla R, Bras M. Sexual and reproductive health and human rights of women living with HIV. J Int AIDS Soc 2015; 18:20834. [PMID: 28326129 PMCID: PMC4813610 DOI: 10.7448/ias.18.6.20834] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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18
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A discussion of key values to inform the design and delivery of services for HIV-affected women and couples attempting pregnancy in resource-constrained settings. J Int AIDS Soc 2015; 18:20272. [PMID: 26643454 PMCID: PMC4672397 DOI: 10.7448/ias.18.6.20272] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/28/2015] [Accepted: 09/22/2015] [Indexed: 12/18/2022] Open
Abstract
Introduction HIV-affected women and couples often desire children and many accept HIV risk in order to attempt pregnancy and satisfy goals for a family. Risk reduction strategies to mitigate sexual and perinatal HIV transmission include biomedical and behavioural approaches. Current efforts to integrate HIV and reproductive health services offer prime opportunities to incorporate strategies for HIV risk reduction during pregnancy attempts. Key client and provider values about services to optimize pregnancy in the context of HIV risk provide insights for the design and implementation of large-scale “safer conception” programmes. Discussion Through our collective experience and discussions at a multi-disciplinary international World Health Organization–convened workshop to initiate the development of guidelines and an algorithm of care to support the delivery of services for HIV-affected women and couples attempting pregnancy, we identified four values that are key to the implementation of these programmes: (1) understanding fertility care and an ability to identify potential fertility problems; (2) providing equity of access to resources enabling informed decision-making about reproductive choices; (3) creating enabling environments that reduce stigma associated with HIV and infertility; and (4) creating enabling environments that encourage disclosure of HIV status and fertility status to partners. Based on these values, recommendations for programmes serving HIV-affected women and couples attempting pregnancy include the following: incorporation of comprehensive reproductive health counselling; training to support the transfer and exchange of knowledge between providers and clients; care environments that reduce the stigma of childbearing among HIV-affected women and couples; support for safe and voluntary disclosure of HIV and fertility status; and increased efforts to engage men in reproductive decision-making at times that align with women's desires. Conclusions Programmes, policies and guidelines that integrate HIV treatment and prevention, sexual and reproductive health and fertility care services in a manner responsive to user values and preferences offer opportunities to maximize demand for and use of these services. For HIV-affected women and couples attempting pregnancy, the provision of comprehensive services using available tools – and the development of new tools that are adaptable to many settings and follow consensus recommendations – is a public health imperative. The impetus now is to design and deliver value-driven inclusive programming to achieve the greatest coverage and impact to reduce HIV transmission during pregnancy attempts.
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19
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Reis CBDS, Araújo MAL, Andrade RFV, Miranda AEB. PREVALENCE AND FACTORS ASSOCIATED WITH PATERNITY INTENTION AMONG MEN LIVING WITH HIV/AIDS IN FORTALEZA, CEARÁ. ACTA ACUST UNITED AC 2015. [DOI: 10.1590/0104-0707201500003560014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of this study was to analyze the prevalence and factors associated with paternity intention in 162 men with HIV/AIDS in Fortaleza, Ceará. Data were collected from June to September 2012 using a questionnaire in reference outpatient centers. Pearson's chi-squared test and logistic regression model were used for analysis. In all, 41.4% of men had the intention to have children. Age <35 years (p<0.001), desire to have children before diagnosis (p<0.001), relationship for less than five years (p=0.022), partner's desire to have children (p<0.001), having no children with the partner (p=0.047), partner without children (p=0.032) and therapy for more than three years (p=0.030) presented significant statistical association with men's desire to have children. In the multivariate analysis, the desire to have children before diagnosis (p=0.004; OR:9.81; CI:1.84-52.20) and partner's desire to have children (p<0.001; OR:9.72; CI:3.48-27.12) remained statistically significant. Many men still intend to be fathers even after the HIV/AIDS diagnosis.
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20
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Nedjat S, Moazen B, Rezaei F, Hajizadeh S, Majdzadeh R, Setayesh HR, Mohraz M, Gooya MM. Sexual and reproductive health needs of HIV-positive people in Tehran, Iran: a mixed-method descriptive study. Int J Health Policy Manag 2015; 4:591-8. [PMID: 26340488 DOI: 10.15171/ijhpm.2015.68] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 03/14/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND People Living with HIV (PLHIV) are highly stigmatized and consequently hard-to-access by researchers and importantly, public health outreach in Iran, possibly due to the existing socio-cultural situation in this country. The present study aimed to evaluate the sexual and reproductive health needs of PLHIV in Tehran, the capital of Iran. METHODS As a mixed-method descriptive study, this project was conducted in 2012 in Tehran, Iran. In this study, we evaluated and discussed socio-demographic characteristics, family and social support, sexual behaviors, fertility desires and needs, PMTCT services, contraceptive methods, unintended pregnancy and safe abortion, and Pap smear tests among 400 participants referring to the behavioral disorders consulting centers. RESULTS Of the sample 240 (60%) were male and 160 (40%) were female. About 50% of women and 40% of men were 25-34 years old. More than 60% of men and 96% of women were married, while more than 50% of the participants had HIV-positive spouses at the time of study. According to the results, fertility desire was observed among more than 30% of female and 40% of male participants. Results of the in-depth interviews indicate that the participants are not satisfied with most of the existing services offered to address their sexual and reproductive health needs. CONCLUSION Despite the availability of services, most of sexual and reproductive health needs of the PLHIV are overlooked by the health system in Iran. Paying attention to sexual and reproductive health needs of PLHIV in Iran not only protects their right to live long and healthy lives, but also may prevent the transmission of HIV from the patients to others within the community.
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Affiliation(s)
- Saharnaz Nedjat
- School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Moazen
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farimah Rezaei
- Obstetrics and Gynecologist, Shahid Beheshti Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shayesteh Hajizadeh
- Department of Midwifery and Reproductive Health, Nursing and Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Maternal and Child Health, Nursing and Midwifery School, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Setayesh
- Regional Support Team for the Middle East and North Africa (RST-MENA), Cairo, Egypt
| | - Minoo Mohraz
- Iranian Research Center for HIV and AIDS, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Gooya
- Centre for Infectious Disease Control, Ministry of Health and Medical Education, Tehran, Iran
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21
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Cooper D, Mantell JE, Moodley J, Mall S. The HIV epidemic and sexual and reproductive health policy integration: views of South African policymakers. BMC Public Health 2015; 15:217. [PMID: 25879464 PMCID: PMC4389705 DOI: 10.1186/s12889-015-1577-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integration of sexual and reproductive health (SRH) and HIV policies and services delivered by the same provider is prioritised worldwide, especially in sub-Saharan Africa where HIV prevalence is highest. South Africa has the largest antiretroviral treatment (ART) programme in the world, with an estimated 2.7 million people on ART, elevating South Africa's prominence as a global leader in HIV treatment. In 2011, the Southern African HIV Clinicians Society published safer conception guidelines for people living with HIV (PLWH) and in 2013, the South African government published contraceptive guidelines highlighting the importance of SRH and fertility planning services for people living with HIV. Addressing unintended pregnancies, safer conception and maternal health issues is crucial for improving PLWH's SRH and combatting the global HIV epidemic. This paper explores South African policymakers' perspectives on public sector SRH-HIV policy integration, with a special focus on the need for national and regional policies on safer conception for PLWH and contraceptive guidelines implementation. METHODS It draws on 42 in-depth interviews with national, provincial and civil society policymakers conducted between 2008-2009 and 2011-2012, as the number of people on ART escalated. Interviews focused on three key domains: opinions on PLWH's childbearing; the status of SRH-HIV integration policies and services; and thoughts and suggestions on SRH-HIV integration within the restructuring of South African primary care services. Data were coded and analysed according to themes. RESULTS Participants supported SRH-HIV integrated policy and services. However, integration challenges identified included a lack of policy and guidelines, inadequately trained providers, vertical programming, provider work overload, and a weak health system. Participants acknowledged that SRH-HIV integration policies, particularly for safer conception, contraception and cervical cancer, had been neglected. Policymakers supported public sector adoption of safer conception policy and services. Participants interviewed after expanded ART were more positive about safer conception policies for PLWH than participants interviewed earlier. CONCLUSION The past decade's HIV policy changes have increased opportunities for SRH-HIV integration. The findings provide important insights for international, regional and national SRH-HIV policy and service integration initiatives.
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Affiliation(s)
- Diane Cooper
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa.
- School of Public Health, University of Western Cape, Private Bag X17, Bellville, 7535, South Africa.
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, NY, USA.
| | - Jennifer Moodley
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa.
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Sumaya Mall
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa.
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
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22
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Mantell JE, Exner TM, Cooper D, Bai D, Leu CS, Hoffman S, Myer L, Moodley J, Kelvin EA, Constant D, Jennings K, Zweigenthal V, Stein ZA. Pregnancy intent among a sample of recently diagnosed HIV-positive women and men practicing unprotected sex in Cape Town, South Africa. J Acquir Immune Defic Syndr 2014; 67 Suppl 4:S202-9. [PMID: 25436819 PMCID: PMC4251915 DOI: 10.1097/qai.0000000000000369] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexual and reproductive health (SRH) services for HIV-positive women and men often neglect their fertility desires. We examined factors associated with pregnancy intent among recently diagnosed HIV-positive women (N = 106) and men (N = 91) who reported inconsistent condom use and were enrolled in an SRH intervention conducted in public sector HIV care clinics in Cape Town. METHODS Participants were recruited when receiving their first CD4 results at the clinic. All reported unprotected sex in the previous 3 months. Logistic regression identified predictors of pregnancy intent for the total sample and by gender. RESULTS About three fifths of men and one fifth of women reported intent to conceive in the next 6 months. In the full-sample multiple regression analysis, men [adjusted odds ratio (AOR = 6.62)] and those whose main partner shared intent to conceive (AOR = 3.80) had significantly higher odds of pregnancy intent; those with more years of education (AOR = 0.81) and more biological children (AOR = 0.62) had lower odds of intending pregnancy. In gender-specific analyses, partner sharing pregnancy intent was positively associated with intent among both men (AOR = 3.53) and women (AOR = 13.24). Among men, odds were lower among those having more biological children (AOR = 0.71) and those unemployed (AOR = 0.30). Among women, relying on hormonal contraception was negatively associated with intent (AOR = 0.08), and main partner knowing her HIV status (AOR = 5.80) was positively associated with intent to conceive. CONCLUSIONS Findings underscore the importance of providing integrated SRH services, and we discuss implications for clinical practice and care.
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Affiliation(s)
- Joanne E. Mantell
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY
| | - Theresa M. Exner
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY
| | - Diane Cooper
- Women's Health Research Unit, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa
| | - Dan Bai
- Departments of Biostatistics and Epidemiology, Joseph Mailman School of Public Health, Columbia University, New York, NY
| | - Cheng-Shiun Leu
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY
- Departments of Biostatistics and Epidemiology, Joseph Mailman School of Public Health, Columbia University, New York, NY
| | - Susie Hoffman
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY
- Departments of Biostatistics and Epidemiology, Joseph Mailman School of Public Health, Columbia University, New York, NY
| | - Landon Myer
- Division of Epidemiology and Biostatistics, 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
| | - Elizabeth A. Kelvin
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY
- Epidemiology and Biostatistics Program, The City University of New York School of Public Health, Hunter College, New York, NY
| | - Debbie Constant
- Women's Health Research Unit, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa
| | - Karen Jennings
- City of Cape Town Department of Health, Cape Town, South Africa; and
| | - Virginia Zweigenthal
- University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa
| | - Zena A. Stein
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY
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