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Untapped Potential for Safer Conception Messaging to Transform PrEP Rollout and Promote Service Engagement Among Serodiscordant Couples. AIDS Behav 2022; 26:2397-2408. [PMID: 35064850 DOI: 10.1007/s10461-022-03584-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 11/01/2022]
Abstract
Uptake of pre-exposure prophylaxis (PrEP) fell short of targets for Sub-Saharan Africa's initial rollout, revealing the need for more effective promotion strategies. In Uganda, we explored potential benefits and challenges of integrating safer conception messaging to promote PrEP among serodiscordant couples. In-depth interviews were conducted with clients and personnel at three clinics and analyzed thematically. Participants (n = 58) valued PrEP as a safer conception method (SCM) but described lack of integration of safer conception and PrEP services as well as inconsistent practices in prescribing PrEP to couples pursuing conception. Participants reported that the wider population remains largely unaware of PrEP and SCM or harbors misconceptions that PrEP is primarily for highly stigmatized groups like sex workers. Participants further described how heterosexual couples can still be reluctant to test for HIV, unaware of tools like PrEP and SCM that would allow them to continue their relationship and/or pursuit of childbearing. Overall, findings suggest that integrating PrEP and SCM in messaging and services targeting serodiscordant couples holds untapped benefits throughout the HIV prevention cascade.
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Andrews C, Reuter TK, Londono V, Claye L, Aung M, Jolly P. "It's Not Good to Be Sick and Have the Child": Perspectives on Pregnancy After HIV-Positive Diagnosis Among Women in Western Jamaica. Int J Womens Health 2022; 14:565-573. [PMID: 35479291 PMCID: PMC9037423 DOI: 10.2147/ijwh.s352343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To identify factors associated with reproductive decision-making for women living with HIV in Western Jamaica, to assess their confidence in anti-retroviral therapy to reduce the chances of mother to child transmission of HIV, and to better understand the experience of stigmatization surrounding becoming pregnant after HIV diagnosis. Participants and Methods Two focus groups were conducted among women living with HIV in the four parishes of Western Jamaica in 2011. A trained moderator conducted the focus groups along with two student notetakers. Qualitative coding and content analysis were used to identify common themes and exemplary quotations characterizing those themes. Results Participants agree that adherence to antiretroviral therapy as prescribed by a physician facilitates better health and longevity; however, they were conflicted on the efficacy of the therapy to prevent mother to child transmission of the virus. Participants report that becoming pregnant after HIV diagnosis continues to be highly stigmatized. Among participants, fear of MTCT and concern that their children will be mistreated are the primary drivers of reproductive decision-making. Conclusion Despite advances in HIV treatment and assisted technologies to prevent MTCT, participants show skepticism that ARV medication is effective at preventing MTCT. Stigma and discriminatory behavior by community members and health-care professionals continue to shape reproductive decision-making for the women who participated in this study. More informed counseling that includes education on recent advancements in HIV treatment and its efficacy at preventing MTCT should be more widely available to pregnant women. To reduce stigma and discriminatory behavior, this education should extend to the larger community.
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Affiliation(s)
- Courtney Andrews
- Institute for Human Rights, University of Alabama at Birmingham, Birmingham, Alabama, USA, Birmingham, AL, USA
| | - Tina Kempin Reuter
- Institute for Human Rights, University of Alabama at Birmingham, Birmingham, Alabama, USA, Birmingham, AL, USA
| | - Valeria Londono
- Minority Health Research Training, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lea Claye
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maung Aung
- Epidemiology and Research Unit, Western Regional Health Authority, Ministry of Health, Montego Bay, Jamaica
| | - Pauline Jolly
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Pashaei Z, Oskouie F, Moradi-Lakeh M, Jahanfar S, Haghani S. HIV serostatus disclosure to sexual partner: a survey among women in Tehran, Iran. Eur J Med Res 2022; 27:56. [PMID: 35395935 PMCID: PMC8994217 DOI: 10.1186/s40001-022-00663-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disclosure of HIV-positive status in women is associated with many factors. Consequently, status disclosure remains a challenge for Iranian women living with HIV. This study aimed to assess the prevalence, related factors, and reflections of HIV-positive status disclosure to a sexual partner(s) among Iranian women living with HIV. METHODS A cross-sectional study was conducted on 170 HIV-seropositive women. Participants were selected from patients registered in the largest HIV clinic and HIV-positive club of Iran. The "HIV disclosure" questionnaire had 38-items and all the interviews were administered by the researcher. Data were analyzed using SPSS version 21.0 software. We used a logistic regression method to calculate the crude odds ratio (COR) and the adjusted odds ratio (AOR) for self-disclosure as the independent predictor variable and the dependent variable, respectively. RESULTS One hundred and seventy HIV-positive women were enrolled. Most of them had disclosed their HIV status to at least one person (94.1%) and their sexual partners (86.5%). In the univariate analysis, being married (COR = 18.66, 95% CI 5.63-61.87), living with a sexual partner (COR = 4.72, 95% CI 1.92-11.62), being aware of sexual partners' HIV status (COR = 6.20, 95% CI 1.79-21.49), and gaining the support of sexual partner (COR = 9.08, 95% CI 3.48-23.64) were associated with higher odds of HIV status disclosure. In the multivariate analysis, being aware of sexual partners' HIV status, and gaining the support of sexual partners remained associated with HIV status disclosure. Most women reported a positive reflection from their sexual partners after disclosure, however, negative reflections from society were more common compared to sexual partners and family members. CONCLUSION This study shows high overall HIV disclosure proportions. It should be noted that a large number of women were infected by their sexual partners, especially by their spouses. The high rate of transmission in married people indicates an urgent need for more emphasis on appropriate prevention behaviors by infected partners.
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Affiliation(s)
- Zahra Pashaei
- Department of Community Health Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.,Iranian Research Center for HIV/AIDS (IRCHA), Iran Nursing Care, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Oskouie
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran. .,Department of Community Health Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shayesteh Jahanfar
- MPH Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, USA
| | - Shima Haghani
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
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Carroll K, Pottinger AM, Pinkney J, Christie LR, Hamilton PI, Thompson MS. Fertility care expectations: what do PLHIV and health care providers in Jamaica know about assisted reproduction services for safe conception? AIDS Care 2022; 35:1045-1054. [PMID: 34986729 DOI: 10.1080/09540121.2021.2023729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Increased life expectancy among persons living with HIV (PLHIV) has increased the desire for parenthood. It is therefore important that PLHIV and health care providers (HCPs) are aware of the available assisted reproduction services (ARS) for PLHIV facing infertility or unsuppressed viremia. Through secondary data analysis we identified PLHIV who were actively trying to conceive and their knowledge of ARS. As specialized fertility care for PLHIV is managed by Obstetrician/Gynecologists (Ob/Gyns), they were surveyed regarding their attitudes towards working with PLHIV and their awareness and knowledge of ARS with a self-administered questionnaire. In this cross-sectional study, 251 PLHIV and 102 Ob/Gyns were recruited and interviewed using a semi-structured questionnaire. Although most Ob/Gyns (81%) reported being supportive of PLHIV having children, 85% counseled against pregnancy, particularly persons in HIV serodifferent relationships. Significantly more PLHIV under 40 years compared to those over 40 years had heard about ARS (59% vs. 43%, p = .007). Ob/Gyns were more knowledgeable of expensive ARS, while PLHIV's knowledge was more restricted to cheaper more accessible ones. In conclusion Ob/Gyns knowledge gaps and underlying stereotypes may present barriers to PLHIV's uptake of ARS. Additionally, virologically unsuppresed persons in HIV serodifferent relationships may be vulnerable as Ob/Gyns were less supportive of them.
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Affiliation(s)
- Kamali Carroll
- The Hugh Wynter Fertility Management Unit, The University of the West Indies, Kingston, Jamaica
| | - Audrey M Pottinger
- Department of Child and Adolescent Health, The University of the West Indies, Kingston, Jamaica
| | - Jodian Pinkney
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Loxley R Christie
- The Hugh Wynter Fertility Management Unit, The University of the West Indies, Kingston, Jamaica
| | - Pansy I Hamilton
- The Hugh Wynter Fertility Management Unit, The University of the West Indies, Kingston, Jamaica
| | - Monique S Thompson
- Department of Obstetrics and Gynaecology, The University of the West Indies, Kingston, Jamaica
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Young CR, Gill E, Bwana M, Muyindike W, Hock RS, Pratt MC, Owembabazi M, Tukwasibwe D, Najjuma A, Kalyebara P, Natukunda S, Kaida A, Matthews LT. Client and Provider Experiences in Uganda Suggest Demand for and Highlight the Importance of Addressing HIV Stigma and Gender Norms Within Safer Conception Care. AIDS Behav 2022; 26:76-87. [PMID: 34152530 PMCID: PMC8688584 DOI: 10.1007/s10461-021-03343-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 01/03/2023]
Abstract
Safer conception counseling supports HIV-serodifferent couples to meet reproductive goals while minimizing HIV transmission risk, but has not been integrated into routine HIV care. We piloted a novel safer conception program in an established public-sector HIV clinic in Uganda to inform future implementation. In-depth interviews and counseling observations explored experiences of program clients and healthcare providers to assess program acceptability, appropriateness, and feasibility. Fifteen index clients (8 women, 7 men), 10 pregnancy partners, and 10 providers completed interviews; 15 participants were living with HIV. Ten observations were conducted. We identified four emergent themes: (1) High demand for safer conception services integrated within routine HIV care, (2) Evolving messages of antiretroviral treatment as prevention contribute to confusion about HIV prevention options, (3) Gender and sexual relationship power inequities shape safer conception care, and (4) HIV-related stigma impacts safer conception care uptake. These findings confirm the need for safer conception care and suggest important implementation considerations.
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Affiliation(s)
- Cynthia R Young
- Division of Infectious Diseases, University of Kentucky, Lexington, KY
| | - Elizabeth Gill
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mwebesa Bwana
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda,Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Winnie Muyindike
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda,Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Rebecca S. Hock
- Chester M. Pierce, MD, Division of Global Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Madeline C Pratt
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL
| | - Moran Owembabazi
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Deogratius Tukwasibwe
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Paul Kalyebara
- Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Silvia Natukunda
- Chester M. Pierce, MD, Division of Global Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Lynn T. Matthews
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL,Corresponding author:
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Gutin SA, Harper GW, Moshashane N, Ramontshonyana K, Stephenson R, Shade SB, Harries J, Mmeje O, Ramogola-Masire D, Morroni C. Relationship, partner factors and stigma are associated with safer conception information, motivation, and behavioral skills among women living with HIV in Botswana. BMC Public Health 2021; 21:2231. [PMID: 34879845 PMCID: PMC8653588 DOI: 10.1186/s12889-021-12268-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 11/16/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND A significant proportion (20-59%) of people living with HIV in sub-Saharan Africa desire childbearing, are of reproductive age, and are in sero-different relationships (~50%). Thus it is plausible that some portion of new HIV transmissions are due to attempts to become pregnant. Safer conception (SC) methods that effectively reduce the risk of HIV transmission exist and can be made available in resource-constrained settings. Few studies in the region, and none in Botswana, have quantitatively examined the correlates of information, motivation, and behavioral skills for SC uptake. METHODS We surveyed 356 women living with HIV from 6/2018 to 12/2018 at six public-sector health clinics in Gaborone, Botswana. Participants were 18-40 years old, not pregnant, and desired future children or were unsure about their childbearing plans. We examined correlates of SC information, motivation, and behavioral skills using nested linear regression models, adjusting for socio-demographic, interpersonal, and structural variables. RESULTS Knowledge of SC methods varied widely. While some SC methods were well known (medical male circumcision by 83%, antiretroviral therapy for viral suppression by 64%), most other methods were known by less than 40% of participants. Our final models reveal that stigma as well as relationship and partner factors affect SC information, motivation, and behavioral skills. Both internalized childbearing stigma (ß=-0.50, 95%CI:-0.17, -0.02) and perceived community childbearing stigma were negatively associated with SC information (ß=-0.09, 95%CI:-0.80, -0.21). Anticipated (ß=-0.06, 95%CI:-0.12, -0.003) and internalized stigma (ß=-0.27, 95%CI:-0.44; -0.10) were associated with decreased SC motivation, while perceived community childbearing stigma was associated with increased SC motivation (ß=0.07, 95%CI:0.02, 0.11). Finally, internalized childbearing stigma was associated with decreased SC behavioral skills (ß=-0.80, 95%CI: -1.12, -0.47) while SC information (ß=0.24, 95%CI:0.12, 0.36), motivation (ß=0.36, 95%CI:0.15, 0.58), and perceived partner willingness to use SC (ß=0.47, 95%CI:0.36, 0.57) were positively associated with behavioral skills CONCLUSIONS: Low SC method-specific information levels are concerning since almost half (47%) of the study participants reported they were in sero-different relationships and desired more children. Findings highlight the importance of addressing HIV stigma and partner dynamics in interventions to improve SC information, motivation, and behavioral skills.
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Affiliation(s)
- Sarah A Gutin
- Center for AIDS Prevention Studies, Division of Prevention Science, University of California, San Francisco, 550 16th Street, 3rd Floor, 94143, San Francisco, CA, USA.
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, MI, 48109, Ann Arbor, USA.
- Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, 7925, Observatory, Cape Town, South Africa.
| | - Gary W Harper
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, MI, 48109, Ann Arbor, USA
| | - Neo Moshashane
- Botswana Harvard AIDS Institute Partnership Princess Marina Hospital, Private Bag BO 320, Gaborone, Botswana
| | - Kehumile Ramontshonyana
- Botswana Harvard AIDS Institute Partnership Princess Marina Hospital, Private Bag BO 320, Gaborone, Botswana
| | - Rob Stephenson
- Department of Systems, Population and Leadership, School of Nursing, University of Michigan, MI, Ann Arbor, USA
- The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Starley B Shade
- Department of Epidemiology & Biostatistics School of Medicine, University of California, San Francisco, CA, San Francisco, USA
| | - Jane Harries
- Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, 7925, Observatory, Cape Town, South Africa
| | - Okeoma Mmeje
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, MI, 48109, Ann Arbor, USA
- Department of Obstetrics and Gynecology, University of Michigan Medical School, MI, Ann Arbor, USA
| | - Doreen Ramogola-Masire
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Chelsea Morroni
- Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, 7925, Observatory, Cape Town, South Africa
- Botswana Harvard AIDS Institute Partnership Princess Marina Hospital, Private Bag BO 320, Gaborone, Botswana
- MRC Centre for Reproductive Health, University of Edinburgh, 47 Little France Crescent, EH16 4TJ, Edinburgh, United Kingdom
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Knowledge and perceptions of preconception care among health workers and women of reproductive age in Mzuzu City, Malawi: a cross-sectional study. Reprod Health 2021; 18:229. [PMID: 34775983 PMCID: PMC8591898 DOI: 10.1186/s12978-021-01282-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 11/02/2021] [Indexed: 11/22/2022] Open
Abstract
Background Preconception care is one of the preventive strategies in maternal and new-born health as recommended by WHO. However, in sub-Saharan Africa there is poor preconception care practices. This study examined knowledge and perceptions of preconception care among health workers and women of reproductive age group in Mzuzu City, Malawi. Methods A descriptive cross-sectional study was conducted using a mixed methods approach. Selection of respondents was done through a multistage and purposive sampling techniques respectively. A total of 253 women of reproductive age from nine townships of Mzuzu City responded to the questionnaire and 20 health workers were interviewed. Results A total of 136 (54%) respondents had heard of preconception care. About 57.7% (n = 146) demonstrated a good level of knowledge of preconception care while 42.3% (n = 107) had poor knowledge. About 72% (n = 105) of those with good of knowledge of preconception care, lacked awareness on possibilities of talking to a health care provider on intentions of getting pregnant. About 74.7% (n = 189) of women had a positive perception towards preconception care. Knowledge of preconception care was a good predictor of positive perception (AOR = 2.5; 95% CI 1.2–5.0), however its predictability was influenced by the academic level attained. Those with secondary (AOR = 10.2; 95% CI 3.2–26.2) and tertiary (AOR = 2.3; 95% CI 1.1–4.9) were more likely to have good knowledge of preconception care than those with primary school education level. About 95% (n = 19) of health workers lacked details about preconception care but they admitted their role in preconception care. Conclusion Preconception care practice among health workers and women of reproductive age in Mzuzu City was low. However there was positive perception towards preconception care in both parties. There is an opportunity in existing platforms for implementation of interventions targeting identified predictors for increased knowledge and uptake of preconception care. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01282-w. World health organization defines preconception care as the provision of biomedical, behavioral and social interventions to women and couples before the occurrence of conception. In sub-Saharan Africa, there is poor preconception care practices which has resulted into high infant and maternal mortalities. This study examined the knowledge and perceptions of preconception care among health workers and women of reproductive age in order to provide evidence based outcomes for tailored interventions and policy direction. A semi-structured questionnaire and structured interviews were used to assess the knowledge level and perceptions of preconception care among women of reproductive age and health workers respectively. Of the 253 women, 57.7% showed good level of knowledge of preconception care while 42.3% had poor knowledge. Most (72%) women with good knowledge level lacked awareness that they can talk to a health worker before getting pregnant. Most (74.7%) women showed a positive perception towards preconception care which was strongly linked to having good knowledge based on the academic level attained. Those with secondary and tertiary backgrounds were more likely to have good knowledge than those with primary school level education. The majority (95%) of health workers were unable to explain well about preconception care but they admitted their role in preconception care.
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Gutin SA, Harper GW, Moshashane N, Bitsang C, Harries J, Ramogola-Masire D, Morroni C. "What if they are pre-conception? What should we do?": Knowledge, practices, and preferences for safer conception among women living with HIV and healthcare providers in Gaborone, Botswana. Front Glob Womens Health 2021; 1. [PMID: 33693437 PMCID: PMC7943178 DOI: 10.3389/fgwh.2020.582463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Safer conception interventions that address HIV care, treatment, and prevention for HIV-affected couples are increasingly available in sub-Saharan Africa. Botswana, an HIV endemic country, is yet to offer formal safer conception services although universal test-and-treat approaches mean that increasing numbers of young, sexually active people living with HIV will start treatment and likely desire childbearing. In order to advance the safer conception discussion in Botswana, it is necessary to understand the current safer conception knowledge, practices, and preferences of healthcare providers and women living with HIV (WLHIV). We conducted qualitative in-depth interviews with 10 HIV healthcare providers and 10 WLHIV in Gaborone. Interviews were analyzed using a phenomenological approach. Safer conception knowledge was limited and safer conception discussions were rare. Healthcare provider and WLHIV preferences were at odds, with providers preferring WLHIV to initiate safer conception discussions, and WLHIV desiring providers to initiate safer conception discussions. Quotes from women and providers highlight deeper issues about power dynamics, concerns about stigma among women, and provider fears about promoting pregnancy. Providers emphasized the need for guidelines and training in order to improve the provision of safer conception counseling. These findings point to areas where safer conception in Botswana can be improved. Both WLHIV and providers would benefit from having information about a range of safer conception methods and approaches. In addition, since WLHIV felt hesitant about initiating safer conception conversations and feared stigma, and because putting the onus for starting safer conception discussions on women is a reversal of normal roles and power structures, providers must take the lead and routinely initiate fertility desire and safer conception discussions. Assisting healthcare providers with clear safer conception guidelines and training would improve the provision of accurate safer conception counseling and facilitate reproductive choice.
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Affiliation(s)
- Sarah A Gutin
- Dept. of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.,Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Center for AIDS Prevention Studies, Division of Prevention Science, University of California San Francisco, San Francisco, CA, USA
| | - Gary W Harper
- Dept. of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Christina Bitsang
- Career and Counseling Services, University of Botswana, Gaborone, Botswana
| | - Jane Harries
- Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Doreen Ramogola-Masire
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Chelsea Morroni
- Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Botswana U-Penn Partnership, Gaborone, Botswana.,Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
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De Vincentis S, Tartaro G, Rochira V, Santi D. HIV and Sexual Dysfunction in Men. J Clin Med 2021; 10:jcm10051088. [PMID: 33807833 PMCID: PMC7961513 DOI: 10.3390/jcm10051088] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022] Open
Abstract
Sexual issues tend to go unaddressed in human immunodeficiency virus (HIV) management, although overt sexual dysfunctions are more prevalent in people living with HIV than uninfected people. Erectile dysfunction is the most frequent sexual problem, with a prevalence of 30–50% even in men <40 years of age, but other issues such as loss of libido and ejaculatory disorders should not be overlooked. Peculiar factors related to HIV infection (e.g., fear of virus transmission, changes in body image, HIV-related comorbidities, HIV distress and stigma), alongside classical factors non-related to HIV, should be considered when approaching sexual problems in HIV patients. For this reason, the diagnostic and therapeutic workout of sexual dysfunction in the context of HIV requires a multidisciplinary approach, involving specialists in both infectious diseases and sexual medicine. This narrative review presents an overview of current knowledge on sexual dysfunction in HIV men, deepening the factors driving and taking part in these issues, providing advice for the clinical approach, and underlining the importance of caring for sexual health to improve the quality of life of HIV patients.
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Affiliation(s)
- Sara De Vincentis
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
| | - Giulia Tartaro
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
- Correspondence: ; Tel.: +39-059-396-2453; Fax: +39-059-396-1335
| | - Daniele Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
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Gutin SA, Harper GW, Moshashane N, Ramontshonyana K, Mompe A, Fleming PJ, Harries J, Ramogola-Masire D, Morroni C. "I did not know about all these": Perceptions regarding safer conception methods by women living with HIV in Gaborone, Botswana. PLoS One 2020; 15:e0242992. [PMID: 33259505 PMCID: PMC7707558 DOI: 10.1371/journal.pone.0242992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 11/12/2020] [Indexed: 11/19/2022] Open
Abstract
Various safer conception methods to limit HIV transmission risks can be offered in resource-constrained settings. However, implementation of safer conception services remains limited in many countries, including Botswana. Understanding perceptions about safer conception methods and the benefits and challenges to use can help with the development of policies, interventions, and service delivery models. Forty-five women living with HIV in the greater Gaborone, Botswana area participated in focus group discussions. Themes were analyzed using interpretive phenomenology. Despite low knowledge of specific safer conception methods that can be used to prevent transmission of HIV when trying to achieve pregnancy, there was noted interest in pre-exposure prophylaxis and vaginal insemination. Challenges to greater uptake were noted including a lack of knowledge about a range of SC methods, limited partner support and communication, provider stigma, health systems barriers, current policies, and the cultural acceptability of methods. Interventions will need to address these challenges and be responsive to the needs and reflect the realities of WLHIV who desire pregnancy in order for safer conception uptake to become a common practice.
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Affiliation(s)
- Sarah A. Gutin
- Dept. of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
- Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, United States of America
| | - Gary W. Harper
- Dept. of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Neo Moshashane
- Botswana—University of Pennsylvania Partnership, University of Botswana Main Campus, Gaborone, Botswana
| | - Kehumile Ramontshonyana
- Botswana—University of Pennsylvania Partnership, University of Botswana Main Campus, Gaborone, Botswana
| | - Atlang Mompe
- Botswana—University of Pennsylvania Partnership, University of Botswana Main Campus, Gaborone, Botswana
| | - Paul J. Fleming
- Dept. of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Jane Harries
- Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Doreen Ramogola-Masire
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Chelsea Morroni
- Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Botswana—University of Pennsylvania Partnership, University of Botswana Main Campus, Gaborone, Botswana
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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11
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MIRZAEI-ALAVIJEH MEHDI, JALILIAN FARZAD, MOTLAGH MOHAMMADESMAIEL, SAADATFAR ABDOLLAH, FATTAHI MOHHAMAD. HIV/AIDS knowledge among Iranian Health Care Workers. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E386-E391. [PMID: 33150227 PMCID: PMC7595077 DOI: 10.15167/2421-4248/jpmh2020.61.3.1474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/31/2020] [Indexed: 11/25/2022]
Abstract
Background HIV/AIDS remains a major public health concern globally and Health Care Workers (HCWs) are in the frontline of preventing and providing care in the health care system. The aim of this study was to evaluate HIV/AIDS knowledge among Iranian HCWs. Methodology This cross-sectional study was conducted among 200 HCWs who were randomly selected from health care centers in Kermanshah city, west of Iran, 2018. HCWs filled out a self-administered questionnaire including the socio-demographic characteristics and HIV/AIDS knowledge items. Data were analyzed by SPSS version 16 using bivariate correlations, t-test, and ANOVA statistical tests. Results The mean score of HIV/AIDS knowledge was 29.73 [95% CI: 28.79, 30.67], ranged from 0 to 40 (74.3% of total percent). There was no significant association and correlation between HIV/AIDS knowledge and sex, education level, marital status, age and job history. Up to 50% had inadequate knowledge about HIV/AIDS status and transmission in Iran. Conclusions HCWs HIV/AIDS knowledge was average and it seems need to be educating regarding HIV/AIDS status and transmission in Iran.
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Affiliation(s)
- MEHDI MIRZAEI-ALAVIJEH
- Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - FARZAD JALILIAN
- Lifestyle Modification Research Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Correspondence: Farzad Jalilian, Lifestyle Modification Research Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran, 67198-51351 - Tel (Fax). +988338263048 -
| | - MOHAMMAD ESMAIEL MOTLAGH
- Department of Pediatrics, Faculty Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - ABDOLLAH SAADATFAR
- Department of Urology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - MOHHAMAD FATTAHI
- Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Using Andersen's Behavioral Model of Health Care Utilization to Assess Contraceptive Use among Sexually Active Perinatally HIV-Infected Adolescents in Uganda. Int J Reprod Med 2020; 2020:8016483. [PMID: 33062664 PMCID: PMC7542496 DOI: 10.1155/2020/8016483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/04/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022] Open
Abstract
Background Contraceptive practices of perinatally HIV-infected adolescents (PHIAs) have implications related to pregnancy prevention, risks of HIV heterosexual transmission, reinfection, and vertical transmission. The study assessed contraceptive use among sexually active PHIAs in Uganda. Methods Mixed methods consisting of a survey and in-depth interviews were employed among 213 sexually active PHIAs who were attending antiretroviral therapy (ART) clinics. The study was guided by Andersen's Behavioral Model of Health Service Use as a theoretical framework to identify factors that influence contraceptive use. These factors include health care factors, personal characteristics, enabling factors, and needs. The outcome was contraceptive use. Multivariable logistic regression was used to establish determinants of contraceptive use. Qualitative data were analyzed by thematic analysis. Results Most PHIAs were female (67.6%); the mean (SD) and median (IQR) age was 17.5 (±1.4) and 18 (17-19) years. The mean age of sexual debut and at marriage were 15 (±1.7) and 17 (±1.1), respectively. Condoms were the most known method of family planning (indicated by 55.4%). Only 16.9% of the participants knew about dual protection (condom use for FP as well as HIV/STI prevention). Of the PHIAs, 43.6% had ever used modern contraception and 56.9% of the females had ever been pregnant. The odds of contraceptive ever-use were significantly higher among adolescents aged 17-19 years (OR 5.1, 95% CI: 2.1-13.3) compared to those aged 10-16 years, those in school (OR 1.8, 95% CI: 1.07-3.2) compared to those out of school, and those with perceived need to use FP (OR 2.0, 95% CI: 1.1-3.9) compared to their counterparts. The odds of contraceptive used were lower among females (OR 0.13, 95% CI: 0.06-0.28) compared to males. From the in-depth interviews, the attitude of health workers, availability of health workers, having a friend using family planning, and waiting time were viewed to affect contraceptive use. Conclusion Contraceptive use among sexually active perinatally HIV-infected adolescents was (43.6%). However, out of those who used family planning majority were using short-term methods. The unmet need for family planning was high (47%) with high reports of pregnancy (56.9%). The factors associated with contraceptive use included education, age, sex (predisposing factors), and perceived need of family planning (need factors). Other factors that could affect contraceptive use from qualitative analysis included attitude of health workers, availability of health workers, having a friend using family planning (predisposing factors), and waiting time (health system factors). HIV care for adolescents should be promoted using SRH approach. There is a need to provide training for all providers to cater for SRH services. We should continue to provide youth-responsive adolescent sexual and reproductive health services across all ART facilities and build a supportive environment and continue to integrate SRH services into HIV care.
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Gutin SA, Harper GW, Bitsang C, Moshashane N, Ramogola-Masire D, Harries J, Morroni C. Perspectives about childbearing and pregnancy planning amongst people living with HIV in Gaborone, Botswana. CULTURE, HEALTH & SEXUALITY 2020; 22:1063-1079. [PMID: 31478784 PMCID: PMC7182082 DOI: 10.1080/13691058.2019.1650202] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 07/26/2019] [Indexed: 06/10/2023]
Abstract
Despite advances in clinical care, safer conception services are not utilised in many high HIV prevalence countries, including Botswana. We conducted in-depth interviews with 10 HIV healthcare providers and 10 women living with HIV to develop a deeper understanding of attitudes surrounding childbearing and pregnancy planning. Interviews were analysed using a phenomenological approach. Providers felt it was a human right and normative for women living with HIV to have children but also expressed concern about women living with HIV having children. Women themselves anticipated stigma from providers regarding childbearing, although most described supportive care and had not experienced stigmatising treatment. Although providers believed pregnancies amongst women living with HIV were unplanned, women described discussing pregnancy desires with sexual partners. Despite providers voicing a rights-based approach to childbearing amongst women living with HIV, hesitancy towards pregnancy remains. This is felt by women living with HIV and perceived as stigma, which may make them less likely to seek fertility and safer conception advice. Safer conception interventions are unlikely to be successful if women do not feel comfortable discussing childbearing with health-care providers.
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Affiliation(s)
- Sarah A. Gutin
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Gary W. Harper
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Christina Bitsang
- Career and Counselling Services, University of Botswana, Gaborone, Botswana
| | - Neo Moshashane
- Botswana - University of Pennsylvania Partnership, University of Botswana Main Campus, Gaborone, Botswana
| | - Doreen Ramogola-Masire
- Department of Obstetrics and Gynaecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Jane Harries
- Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Chelsea Morroni
- Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Botswana - University of Pennsylvania Partnership, University of Botswana Main Campus, Gaborone, Botswana
- Liverpool School of Tropical Medicine, Liverpool, UK
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Yam EA, Kahabuka C, Mbita G, Winani K, Apicella L, Casalini C, Mbuguni Z. Safer conception for female sex workers living with HIV in Dar es Salaam, Tanzania: Cross-sectional analysis of needs and opportunities in integrated family planning/HIV services. PLoS One 2020; 15:e0235739. [PMID: 32692777 PMCID: PMC7373272 DOI: 10.1371/journal.pone.0235739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 06/23/2020] [Indexed: 11/29/2022] Open
Abstract
Background With the advent of effective treatment, women living with HIV can plan for pregnancy while minimizing risk of transmission to infants and seronegative partners. Family planning (FP) services tend to focus solely on addressing contraceptive need, but HIV-positive women—including female sex workers—often plan to have children someday. Various “safer conception” strategies are now available to support women living with HIV achieve fertility intentions, and integrated HIV/FP services may be a promising platform to offer these services. Methods At integrated community-based HIV/FP service delivery sites operated by Jhpiego’s Sauti project in Dar es Salaam, we conducted exit interviews with 300 HIV-positive female sex workers. Descriptive analyses were conducted to describe their desire for children, use of condoms and other modern contraceptive methods, self-reported viral suppression, and knowledge of and interest in safer conception strategies. We conducted bivariate and multivariate logistic regression analysis to examine correlates of fertility desire among respondents. Results Median age of participants was 32. Nearly one-third wished to have a child within two years. Seventy-two percent had heard of having the HIV-positive partner taking ART to reduce sexual transmission during pregnancy attempts. Thirty-one percent felt the amount of FP content covered in the consultation was “too little.” Factors significantly associated with desire for children were having a nonpaying partner (adjusted odds ratio [AOR] 2.18, 95% confidence interval [CI]1.13–4.20) and having fewer children (AOR 0.65, 95% CI 0.48–0.87). Viral suppression was not associated with fertility desire. Conclusions Sex workers living with HIV attending integrated HIV/FP services have need for both contraception as well as safer conception counseling. This integrated service delivery modality is a promising platform for providing safer conception services. FP counseling for HIV-positive women should be broadened to broach the topic of safer pregnancy, as well as explicit counseling on strategies to minimize risk of sexual transmission to partners.
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Affiliation(s)
- Eileen A. Yam
- Population Council, Washington, DC, United States of America
- * E-mail:
| | | | | | - Koheleth Winani
- Reproductive and Child Health Section, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | | | | | - Zuhura Mbuguni
- Reproductive and Child Health Section, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
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Garver S, Trinitapoli J, Yeatman S. Changing Childbearing Norms During an Era of ART Expansion in Malawi, 2009 to 2015. AIDS Behav 2020; 24:1676-1686. [PMID: 31612333 PMCID: PMC7153966 DOI: 10.1007/s10461-019-02685-4] [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: 10/25/2022]
Abstract
Community norms shape the childbearing goals and behaviors of persons living with HIV/AIDS (PLWHA) but little is known about how norms around HIV-positive childbearing have changed with expanded access to antiretroviral treatment (ART). We analyze data collected in 2009 and 2015 by the Tsogolo la Thanzi (TLT) project-a longitudinal, population-based study of young adults in southern Malawi. Respondents were asked about the acceptability of childbearing using vignettes that varied a hypothetical couple's HIV status and number of children. We assess mean differences in support for childbearing over time and by respondent gender and serostatus. The acceptability of childbearing for PLWHA increased dramatically over the 6-year period; however, support levels varied based on a couple's current number of children and whether they were seropositive concordant or discordant. Differences in attitudes by gender and HIV status diminished over time, pointing to a population-level convergence in norms about acceptable childbearing.
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Affiliation(s)
- Sarah Garver
- Sociology Department, University of Chicago, Chicago, USA.
- Social Science Research Center, 1155 E 60th St, Chicago, IL, 60615, United States.
| | | | - Sara Yeatman
- Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, USA
- University of Colorado Population Center (CUPC), Boulder, USA
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Gutin SA, Harper GW, Amico KR, Bitsang C, Moshashane N, Harries J, Ramogola-Masire D, Morroni C. 'I'm waiting for that': Interest in the use of PrEP for safer conception in Botswana. Glob Public Health 2020; 15:1200-1211. [PMID: 32175819 DOI: 10.1080/17441692.2020.1741663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Safe and effective low-cost safer conception (SC) methods are increasingly available and being integrated into national guidelines in sub-Saharan African contexts. Sero-different couples of childbearing age can benefit from such services and the routine provision of SC counselling. Pre-exposure prophylaxis (PrEP) to prevent HIV acquisition to uninfected partners can reduce the chances of HIV transmission when trying to achieve pregnancy. Botswana has a strong commitment to reducing new HIV infections but PrEP is not yet widely available and little guidance has been offered on counselling sero-different couples. We conducted qualitative in-depth interviews in Gaborone, Botswana with 10 HIV healthcare providers and 10 women living with HIV of childbearing age because they act as a key conduit for reaching sero-different partners with information about PrEP. We examined knowledge and attitudes towards PrEP to assess the viability and develop a deeper understanding of this SC option. Interviews were analysed using an interpretive phenomenological approach. Three themes emerged: (1) awareness of PrEP is limited, (2) providers and women overwhelmingly showed interest in PrEP and (3) women living with HIV and providers have concerns about PrEP use. With the correct support, PrEP could be a useful SC option for sero-different couples in Botswana and other sub-Saharan contexts.
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Affiliation(s)
- Sarah A Gutin
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.,Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Center for AIDS Prevention Studies, Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Gary W Harper
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - K Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Christina Bitsang
- Career and Counseling Services, University of Botswana, Gaborone, Botswana
| | | | - Jane Harries
- Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Doreen Ramogola-Masire
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Chelsea Morroni
- Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Botswana U-Penn Partnership, Gaborone, Botswana.,Liverpool School of Tropical Medicine, Liverpool, UK
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Iliyasu Z, Galadanci HS, Zubairu AA, Amole TG, Sam-Agudu NA, Aliyu MH. Health workers' knowledge of safer conception and attitudes toward reproductive rights of HIV-infected couples in Kano, Nigeria. Int Health 2020; 11:536-544. [PMID: 31028377 DOI: 10.1093/inthealth/ihz016] [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: 06/27/2018] [Revised: 01/28/2019] [Accepted: 03/01/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The restriction of reproductive rights of HIV-positive couples in low-resource settings could be related to the attitudes and skills of health workers. We assessed health workers' knowledge of safer conception and their attitudes toward the reproductive rights of HIV-positive couples in a tertiary hospital in Nigeria. METHODS A cross-section of health workers (n=294) was interviewed using structured questionnaires. Knowledge and attitude scores were analyzed. Logistic regression was employed to generate adjusted odds ratios (AORs) for predictors of attitude. RESULTS Safer conception methods mentioned by respondents included timed unprotected intercourse with (27.9%) and without antiretroviral pre-exposure prophylaxis (37.4%), in vitro fertilization plus intracytoplasmic sperm injection (26.5%), and sperm washing and intrauterine insemination (24.8%). The majority (94.2%) of health workers acknowledged the reproductive rights of HIV-infected persons, although (64.6%) strongly felt that HIV-infected couples should have fewer children. Health workers reported always/nearly always counseling their patients on HIV transmission risks (64.1%) and safer conception (59.2% and 48.3% for females and males, respectively) (p<0.05). Among health workers, being older (30-39 vs <30 y) (AOR=1.33, 95% CI=1.13-2.47), married (AOR=2.15, 95% CI=1.17-5.58) and having a larger HIV-positive daily caseload (20-49 vs <20) (AOR=1.98, 95% CI=1.07-3.64) predicted positive attitude towards reproductive rights of HIV-affected couples. CONCLUSIONS Health workers had limited knowledge of safer conception methods, but were supportive of the reproductive rights of HIV-positive couples. Health workers in Nigeria require training to effectively counsel couples on their reproductive rights, risks and options.
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Affiliation(s)
- Zubairu Iliyasu
- Departments of Community Medicine, Bayero University, PMB 3011 Kano, Kano State, Nigeria.,Centre for Infectious Diseases Research, Bayero University, PMB 3011 Kano, Kano State, Nigeria
| | - Hadiza S Galadanci
- Departments of Obstetrics and Gynecology, Bayero University, PMB 3011 Kano, Kano State, Nigeria
| | - Ahmad A Zubairu
- Departments of Community Medicine, Bayero University, PMB 3011 Kano, Kano State, Nigeria
| | - Taiwo G Amole
- Departments of Community Medicine, Bayero University, PMB 3011 Kano, Kano State, Nigeria
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology, Maina Court, Plot 252, Abuja, Nigeria.,Institute of Human Virology, University of Maryland, 725 W Lombard St, Baltimore, MD 21201, USA
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 725, Nashville, TN 37203, USA
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Kimemia G, Ngure K, Baeten JM, Celum C, Dew K, Njuguna N, Mugo N, Heffron R. Perceptions of pregnancy occurring among HIV-serodiscordant couples in Kenya. Reprod Health 2019; 16:85. [PMID: 31215447 PMCID: PMC6582525 DOI: 10.1186/s12978-019-0751-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/10/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Among HIV serodiscordant couples, most conception involves condomless sex and may confer a period with increased HIV transmission risk if HIV viral load is not suppressed and other precautions are not used. Safer conception strategies enable HIV serodiscordant couples to attain their pregnancy goals while markedly reducing this risk. We explored the perceptions and beliefs held by HIV serodiscordant couples and health care providers concerning pregnancy among HIV serodiscordant couples in Kenya and gathered their thoughts about how these might influence use of safer conception methods. METHODS We conducted 20 Key Informant Interviews (KIIs) with health care providers offering safer conception counseling and 21 In-Depth Interviews (IDIs) and 4 Focus Group Discussions (FGDs) with members of HIV serodiscordant couples with immediate pregnancy goals in Thika, Kenya. Data were analyzed using an inductive approach that identified two emergent themes: perceptions towards pregnancy among HIV serodiscordant couples and access to safer conception services. RESULTS The perceptions held by the community towards couples in HIV serodiscordant relationships having children were largely negative. The participants were aware of the increased HIV transmission risk to the HIV uninfected partners while trying to become pregnant. In the community, having biological children was cherished yet the majority of the couples shied away from accessing safer conception services offered at health facilities due to stigma and lack of knowledge of the existence of such services. Some providers had limited knowledge on safer conception strategies and services and consequently discouraged HIV serodiscordant couples from natural conception. CONCLUSIONS Negative perceptions towards HIV serodiscordant couples becoming pregnant has hindered access to safer conception services. Therefore, there is need to create a supportive environment for HIV serodiscordant couples with fertility intentions that normalizes their desire to have children and informs the community about the availability of safer conception services.
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Affiliation(s)
- Grace Kimemia
- African Population & Health Research Center, Nairobi, Kenya
| | - Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Jared M. Baeten
- Department of Global Health, University of Washington, 325 Ninth Avenue Box 359927, Seattle, WA 98104 USA
- Department of Epidemiology, University of Washington, 325 Ninth Avenue Box 359927, Seattle, WA 98104 USA
- Department of Medicine, University of Washington, Seattle, USA
| | - Connie Celum
- Department of Global Health, University of Washington, 325 Ninth Avenue Box 359927, Seattle, WA 98104 USA
- Department of Epidemiology, University of Washington, 325 Ninth Avenue Box 359927, Seattle, WA 98104 USA
- Department of Medicine, University of Washington, Seattle, USA
| | - Kristin Dew
- Department of Human Centered Design and Engineering, University of Washington, Seattle, USA
| | | | - Nelly Mugo
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Renee Heffron
- Department of Global Health, University of Washington, 325 Ninth Avenue Box 359927, Seattle, WA 98104 USA
- Department of Epidemiology, University of Washington, 325 Ninth Avenue Box 359927, Seattle, WA 98104 USA
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Feyissa TR, Harris ML, Melka AS, Loxton D. Unintended Pregnancy in Women Living with HIV in Sub-Saharan Africa: A Systematic Review and Meta-analysis. AIDS Behav 2019; 23:1431-1451. [PMID: 30467712 DOI: 10.1007/s10461-018-2346-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In 2014, about 1.5 million pregnancies occurred among HIV-positive women in low and middle-income countries. To pool magnitude and factors associated with unintended pregnancy in women living with HIV in sub-Saharan Africa, a systematic search of electronic databases was undertaken in November 2016. Pooling the magnitude of unintended pregnancy reported by 14 studies yielded a crude summary prevalence of 55.9%. The magnitude of unwanted pregnancy and mistimed pregnancy in six studies ranged from 14 to 59 and 9 to 47.2%, respectively. Contraceptive failure was an important factor for many unintended pregnancies. The magnitude of unintended pregnancy was significantly higher in HIV-positive women than for HIV-negative women in three out of six studies. The available evidence suggests that there is a high magnitude of unintended pregnancy in this population. Improving effective contraceptive utilization is thus a priority to address unintended pregnancies and to prevent mother to child transmission of HIV. PROSPERO Number: CRD42016051310.
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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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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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Krashin JW, Haddad LB, Tweya H, Chiwoko J, Ng’ambi W, Samala B, Chaweza T, Tang JH, Hosseinipour MC, Phiri S. Factors associated with desired fertility among HIV-positive women and men attending two urban clinics in Lilongwe, Malawi. PLoS One 2018; 13:e0198798. [PMID: 29897961 PMCID: PMC5999219 DOI: 10.1371/journal.pone.0198798] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 05/27/2018] [Indexed: 12/24/2022] Open
Abstract
As access to antiretroviral therapy increases, more HIV-infected patients in sub-Saharan Africa may desire fertility. We conducted a cross-sectional study of reproductive health knowledge, attitudes and practices to identify factors associated with desired fertility among women and men receiving care at two large public HIV clinics in Lilongwe, Malawi. Research assistants administered questionnaires to participants. We performed descriptive, bivariable and multivariable analysis of factors related to desired fertility and of factors related to contraceptive non-use among participants who did not desire fertility. One-third of participants desired future children. Having a partner who desired fertility and having lower parity were associated with desiring children among both genders. For women, believing that pregnancy was unhealthy was associated with decreased fertility desire. Fifty-five percent of women and 69% of men who did not want children in the future reported using contraception at last intercourse. Increasing age, lower parity, and making the decision to use contraception herself were associated with contraceptive non-use among women who did not desire fertility. Having discussed family planning with his partner was associated with contraceptive use among men who did not desire fertility. Knowledge of these factors can guide reproductive health counseling and service provision.
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Affiliation(s)
- Jamie W. Krashin
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Lisa B. Haddad
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Hannock Tweya
- The Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Jane Chiwoko
- The Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
| | | | | | - Thomas Chaweza
- The Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Jennifer H. Tang
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
- UNC Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Mina C. Hosseinipour
- UNC Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Sam Phiri
- The Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
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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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Caplan MR, Phiri K, Parent J, Phoya A, Schooley A, Hoffman RM. Provider perspectives on barriers to reproductive health services for HIV-infected clients in Central Malawi. ACTA ACUST UNITED AC 2018; 4. [PMID: 30828465 DOI: 10.15761/cogrm.1000208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Despite widespread availability of Depo-Provera in HIV clinics in Malawi, coverage of family planning (FP) remains low. We sought to understand provider perspectives about the challenges of providing reproductive health services to HIV-infected clients in antiretroviral therapy (ART) clinics in Central Malawi by conducting surveys and semi structured in-depth interviews with 31 ART providers across 16 clinical sites. Additionally, site surveys were performed to assess contraceptive resources. Major barriers to the provision of FP in ART clinics were inadequate staff in the facility, shortage of trained providers, limited time to counsel on FP, and lack of private space for the provision of FP services. These barriers limit the direct delivery of FP in ART clinics. Strategies to integrate FP with HIV/ART services and task shifting FP service provision to non-ART providers should be explored in Malawi as a means to improve coverage of services to HIV-infected clients.
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Affiliation(s)
- Margaret R Caplan
- Division of HIV Medicine, Los Angeles Biomedical Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | | | | | - Ann Phoya
- UNC Maternal and Safe Motherhood Program, Lilongwe, Malawi
| | - Alan Schooley
- Partners in Hope, Lilongwe, Malawi.,Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Risa M Hoffman
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Abstract
Introduction: HIV reduces fertility through biological and social pathways, and antiretroviral treatment (ART) can ameliorate these effects. In northern Malawi, ART has been available since 2007 and lifelong ART is offered to all pregnant or breastfeeding HIV-positive women. Methods: Using data from the Karonga Health and Demographic Surveillance Site in Malawi from 2005 to 2014, we used total and age-specific fertility rates and Cox regression to assess associations between HIV and ART use and fertility. We also assessed temporal trends in in utero and breastfeeding HIV and ART exposure among live births. Results: From 2005 to 2014, there were 13,583 live births during approximately 78,000 person years of follow-up of women aged 15–49 years. The total fertility rate in HIV-negative women decreased from 6.1 [95% confidence interval (CI): 5.5 to 6.8] in 2005–2006 to 5.1 (4.8–5.5) in 2011–2014. In HIV-positive women, the total fertility rate was more stable, although lower, at 4.4 (3.2–6.1) in 2011–2014. In 2011–2014, compared with HIV-negative women, the adjusted (age, marital status, and education) hazard ratio was 0.7 (95% CI: 0.6 to 0.9) and 0.8 (95% CI: 0.6 to 1.0) for women on ART for at least 9 months and not (yet) on ART, respectively. The crude fertility rate increased with duration on ART up to 3 years before declining. The proportion of HIV-exposed infants decreased, but the proportion of ART-exposed infants increased from 2.4% in 2007–2010 to 3.5% in 2011–2014. Conclusions: Fertility rates in HIV-positive women are stable in the context of generally decreasing fertility. Despite a decrease in HIV-exposed infants, there has been an increase in ART-exposed infants.
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Landolt NK, Achalapong J, Kosalaraksa P, Petdachai W, Ngampiyaskul C, Kerr S, Boonyanurak P, Ananworanich J, Bunupuradah T. Strategies to improve the uptake of effective contraception in perinatally HIV-infected adolescents. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30334-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Landolt NK, Achalapong J, Kosalaraksa P, Petdachai W, Ngampiyaskul C, Kerr S, Boonyanurak P, Ananworanich J, Bunupuradah T. Strategies to improve the uptake of effective contraception in perinatally HIV-infected adolescents. J Virus Erad 2017; 3:152-156. [PMID: 28758023 PMCID: PMC5518244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To assess strategies to improve safe-sex practices in sexually active female adolescents living with HIV, through linking reproductive health (RH) care with HIV care. METHODS A single arm, 48-week prospective study was conducted with 77 sexually active adolescents in five sites in Thailand. Guided RH education was carried out through video, brochures and individual counselling. Participants were offered free effective contraception (EC), in addition to a barrier method (dual contraception) versus barrier method only. Changes in EC use were assessed with McNemar's test; predicting factors with logistic regression. RESULTS Median age was 19 years; 95% were perinatally infected; 30% had been pregnant. All but one showed RH-knowledge improvement after RH education. Individual counselling was most often rated the 'most helpful' educational method. At the screening visit 21% were using dual contraception; 53% a male condom only; 8% EC method only; and 18% were not using any contraceptive method. Dual-contraception use improved with time, reaching 74% at week 48. EC-use at the baseline visit was associated with having ever used EC prior to study entry (P<0.0001), and the study site (P<0.0001). Having ever used EC was associated with a history of pregnancy (P=0.0085) and forced sex (P=0.0386). CONCLUSION Offering continuous RH care, linked with HIV care, resulted in increased use of dual contraception. Healthcare providers played a significant role in the process. RH education should address the main predictors for EC use by adolescents, including past, personal experience.
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Affiliation(s)
- Nadia Kancheva Landolt
- HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT),
Bangkok,
Thailand,Corresponding author: Nadia Kancheva Landolt,
HIV-NAT, Thai Red Cross AIDS Research Centre,
104 Rajdumri Road, Pathumwan,
Bangkok10330,
Thailand
| | | | | | | | | | - Stephen Kerr
- HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT),
Bangkok,
Thailand,Department of Global Health,
University of Amsterdam,
Amsterdam,
the Netherlands
| | | | - Jintanat Ananworanich
- HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT),
Bangkok,
Thailand,SEARCH, Thai Red Cross AIDS Research Centre Bangkok,
Thailand,US Military HIV Research Program,
Silver Spring,
MD,
USA
| | - Torsak Bunupuradah
- HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT),
Bangkok,
Thailand
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Rodriguez VJ, Cook RR, Weiss SM, Peltzer K, Jones DL. Psychosocial correlates of patient-provider family planning discussions among HIV-infected pregnant women in South Africa. Open Access J Contracept 2017. [PMID: 28626358 PMCID: PMC5473338 DOI: 10.2147/oajc.s134124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Patient–provider family planning discussions and preconception counseling can reduce maternal and neonatal risks by increasing adherence to provider recommendations and antiretroviral medication. However, HIV-infected women may not discuss reproductive intentions with providers due to anticipation of negative reactions and stigma. This study aimed to identify correlates of patient–provider family planning discussions among HIV-infected women in rural South Africa, an area with high rates of antenatal HIV and suboptimal rates of prevention of mother-to-child transmission (PMTCT) of HIV. Participants were N=673 pregnant HIV-infected women who completed measures of family planning discussions and knowledge, depression, stigma, intimate partner violence, and male involvement. Participants were, on average, 28 ± 6 years old, and half of them had completed at least 10–11 years of education. Most women were unemployed and had a monthly income of less than ~US$76. Fewer than half of the women reported having family planning discussions with providers. Correlates of patient–provider family planning discussions included younger age, discussions about PMTCT of HIV, male involvement, and decreased stigma (p < 0.05). Depression was indirectly associated with patient–provider family planning discussions through male involvement (b = −0.010, bias-corrected 95% confidence interval [bCI] [−0.019, −0.005]). That is, depression decreased male involvement, and in turn, male involvement increased patient–provider family planning discussions. Therefore, by decreasing male involvement, depression indirectly decreased family planning discussions. Study findings point to the importance of family planning strategies that address depression and facilitate male involvement to enhance communication between patients and providers and optimize maternal and neonatal health outcomes. This study underscores the need for longitudinal assessment of men’s impact on family planning discussions both pre- and postpartum. Increasing support for provision of mental health services during pregnancy is merited to ensure the health of pregnant women living with HIV and their infants.
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Affiliation(s)
- Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ryan R Cook
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Karl Peltzer
- HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, South Africa.,ASEAN Institute for Health Development, Mahidol University, Salaya, Thailand.,Department of Psychology, University of Limpopo, Turfloop, South Africa
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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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: 14] [Impact Index Per Article: 2.0] [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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Brown J, Njoroge B, Akama E, Breitnauer B, Leddy A, Darbes L, Omondi R, Mmeje O. A Novel Safer Conception Counseling Toolkit for the Prevention of HIV: A Mixed-Methods Evaluation in Kisumu, Kenya. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:524-538. [PMID: 27925487 PMCID: PMC5292923 DOI: 10.1521/aeap.2016.28.6.524] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Safer conception strategies can prevent HIV transmission between HIV-discordant partners while allowing them to conceive. However, HIV care providers in sub-Saharan Africa report they are not trained in safer conception, and patients are not routinely offered safer conception services. This mixed-methods pilot study evaluated the impact, acceptability, and feasibility of a novel Safer Conception Counseling Toolkit among providers and patients in Kenya. We enrolled 20 HIV-positive women, 10 HIV-discordant couples, and 10 providers from HIV care and treatment clinics. Providers completed questionnaires before/after training, and then counseled HIV-affected patients. Change in patient knowledge was assessed before/after counseling. Qualitative interviews were conducted among providers and patients. The Toolkit was associated with large, significant increases in patient knowledge, and provider confidence, knowledge, and favorable attitudes toward safer conception counseling; 20% felt confident before versus 100% after training (p < 0.01).
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Affiliation(s)
- Joelle Brown
- Department of Epidemiology and Biostatistics and the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Betty Njoroge
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | | | - Brooke Breitnauer
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Anna Leddy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lynae Darbes
- School of Nursing and the Center for Sexuality and Health Disparities, Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | - Okeoma Mmeje
- Department of Obstetrics and Gynecology, University of Michigan Medical School, and the Department of Health Education and Health Behavior, School of Public Health, University of Michigan
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Low Receipt and Uptake of Safer Conception Messages in Routine HIV Care: Findings From a Prospective Cohort of Women Living With HIV in South Africa. J Acquir Immune Defic Syndr 2016; 72:105-13. [PMID: 26855247 DOI: 10.1097/qai.0000000000000945] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Safer conception strategies may be used by people living with HIV to reduce HIV transmission to partners resulting from condomless sex for conception. The extent to which people living with HIV receive safer conception messages and use risk reduction strategies is largely unknown. METHODS We use prospective data from a clinic-based cohort study in Johannesburg, South Africa. Women living with HIV (WLWH) aged 18-35 on antiretroviral therapy (n = 831) completed a baseline survey and ≥1 follow-up visits assessing fertility intentions and pregnancy incidence; an endline survey was administered 1 year postenrollment. Multivariate negative binomial regression models examined differences in the number of condomless sex acts by fertility intentions. Chi-squared statistics compared receipt of safer conception messages by fertility intentions and indicators of safer conception method use by partner HIV status. RESULTS The median baseline age of participants was 30.4 years and 25.3% were in serodiscordant partnerships. WLWH trying to conceive were over 3 times more likely to have condomless sex compared with those not trying to conceive (adjusted incidence rate ratio: 3.17, 95% confidence interval: 1.95 to 5.16). Receipt of specific safer conception messages was low, although women with positive fertility intentions were more likely to have received any fertility-related advice compared with those with unplanned pregnancies (76.3% vs. 49.1%, P < 0.001). Among WLWH trying to conceive (n = 111), use of timed unprotected intercourse was infrequent (17.1%) and lower in serodiscordant vs. concordant partnerships (8.5% vs. 26.9%, P = 0.010). CONCLUSIONS These findings suggest that clinic and patient-level interventions are needed to ensure that WLWH receive and use safer conception strategies.
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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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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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Addressing gender inequalities to improve the sexual and reproductive health and wellbeing of women living with HIV. J Int AIDS Soc 2015; 18:20302. [PMID: 26643464 PMCID: PMC4672401 DOI: 10.7448/ias.18.6.20302] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 09/11/2015] [Accepted: 09/22/2015] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Globally, women constitute 50% of all persons living with HIV. Gender inequalities are a key driver of women's vulnerabilities to HIV. This paper looks at how these structural factors shape specific behaviours and outcomes related to the sexual and reproductive health of women living with HIV. DISCUSSION There are several pathways by which gender inequalities shape the sexual and reproductive health and wellbeing of women living with HIV. First, gender norms that privilege men's control over women and violence against women inhibit women's ability to practice safer sex, make reproductive decisions based on their own fertility preferences and disclose their HIV status. Second, women's lack of property and inheritance rights and limited access to formal employment makes them disproportionately vulnerable to food insecurity and its consequences. This includes compromising their adherence to antiretroviral therapy and increasing their vulnerability to transactional sex. Third, with respect to stigma and discrimination, women are more likely to be blamed for bringing HIV into the family, as they are often tested before men. In several settings, healthcare providers violate the reproductive rights of women living with HIV in relation to family planning and in denying them care. Lastly, a number of countries have laws that criminalize HIV transmission, which specifically impact women living with HIV who may be reluctant to disclose because of fears of violence and other negative consequences. CONCLUSIONS Addressing gender inequalities is central to improving the sexual and reproductive health outcomes and more broadly the wellbeing of women living with HIV. Programmes that go beyond a narrow biomedical/clinical approach and address the social and structural context of women's lives can also maximize the benefits of HIV prevention, treatment, care and support.
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35
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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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