1
|
Crankshaw TL, Freedman J, Mutambara VM, Rajah Y. "I still don't know how someone gets pregnant": determinants of poor reproductive health among young female refugees in South Africa. BMC Womens Health 2024; 24:10. [PMID: 38172790 PMCID: PMC10765558 DOI: 10.1186/s12905-023-02847-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Studies exploring the sexual and reproductive health (SRH) of refugee women have focused primarily on first generation refugees in humanitarian and crisis settings. There is a paucity of research exploring the reproductive health of girls and young women who are born to refugee parents in a host country or who have migrated with their parents at a very young age and who have since reached sexual maturity. We conducted a qualitative study which aimed to explore the reproductive health and rights' needs and challenges amongst young refugee women in South Africa. METHODS The study was carried out in the city of eThekwini (Durban) in South Africa in 2021 and 2022. A total of 35 semi-structured, in person interviews were conducted amongst young refugee women between the ages of 18 and 24 years living in the city centre. RESULTS Twenty-five participants were 17 years or younger on arriving in South Africa, one of whom was born in South Africa. Eleven of these women had experienced one or more pregnancies while living in South Africa and all of these women had experienced at least one unintended pregnancy. Participants had poor reproductive health knowledge of the role of menstruation and how conception occurs. Economic, social, and legal insecurities intersected in complex ways as determinants of poor reproductive health outcomes. Despite availability, contraceptive use was poor and linked to lack of knowledge, myths and unwanted side effects. There were negative economic and social impacts for young refugee women experiencing early pregnancies irrespective of whether they were intended or not. Being unable to conceive or experiencing an unintended pregnancy negatively impacted sexual relationships which were entered primarily for material support. Desire for confidentiality shaped lack of access to legal termination of pregnancy in the public health sector. CONCLUSION Participants experienced specific vulnerabilities resulting from their position as refugees despite length of stay in South Africa. It is important to better understand these specificities in the design of programmes and policies aimed at ensuring positive health outcomes for these young women. Peer education amongst refugee communities may be an important tool in the provision of culturally acceptable SRH education.
Collapse
Affiliation(s)
- Tamaryn L Crankshaw
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa.
| | - Jane Freedman
- Centre for Sociological and Political Research (CRESPPA), Université Paris 8, Paris, France
| | - Victoria M Mutambara
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | | |
Collapse
|
2
|
Crankshaw TL, Freedman J. Sex work or transactional sex? Shifting the dialogue from risk to rights. Sex Reprod Health Matters 2023; 31:2210859. [PMID: 37351919 PMCID: PMC10291900 DOI: 10.1080/26410397.2023.2210859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Affiliation(s)
| | - Jane Freedman
- Professor, Université Paris 8 CRESPPA_GTM, Paris, France; Visiting Professor, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
3
|
Crankshaw TL, Muparamoto N, Chareka S, Ngwenya P. Intersectional vulnerabilities and differential impacts of COVID-19 responses on young people who sell sex in Zimbabwe. Cult Health Sex 2022:1-15. [PMID: 35913510 DOI: 10.1080/13691058.2022.2101068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 07/09/2022] [Indexed: 06/15/2023]
Abstract
The varying impact of the COVID-19 pandemic on different populations has brought into focus the pre-existing inequalities which shape vulnerabilities amongst marginalised and key populations. More nuanced approaches which understand intersectional vulnerabilities and differential impacts of the pandemic on gender and sexuality diversity within these groups are required. We investigated the economic, social and health impacts of COVID-19 on young people of diverse genders and sexualities who sell sex (16-24 years) in Zimbabwe. We found that all groups had heightened vulnerability to economic and social hardship during the first two COVID waves in Zimbabwe. However, vulnerability was unequally distributed by geography and socio-economic position, as well as by gender and age, both within and between groups of participants. With limited funding resources for the promotion of sexual and reproductive health and rights in the push for universal health coverage, nuanced approaches which include analysis of multidimensional vulnerabilities between and within groups is required to develop the most cost effective and impactful policy and programme interventions.
Collapse
Affiliation(s)
- Tamaryn L Crankshaw
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Nelson Muparamoto
- Wits Centre for Diversity Studies, University of the Witwatersrand, Johannesburg, South Africa
- Demography Settlement and Development, University of Zimbabwe, Harare, Zimbabwe
| | - Samantha Chareka
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Precious Ngwenya
- Department of Development Studies, Faculty of Humanities and Social Sciences, Lupane State University, Lupane, Zimbabwe
| |
Collapse
|
4
|
Mutambara VM, Crankshaw TL, Freedman J. Assessing the impacts of COVID-19 on women refugees in South Africa. J Refug Stud 2021; 35:feab044. [PMCID: PMC8083604 DOI: 10.1093/jrs/feab044] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/01/2021] [Indexed: 07/24/2023]
Abstract
The global COVID-19 pandemic and subsequent lockdowns and restrictions have had uneven impacts on populations and have deepened many pre-existing inequalities along lines of race, ethnicity, class, gender. Refugees have been shown to be particularly negatively impacted in many countries, with existing structures of violence and insecurity worsened by the immediate consequences of the pandemic through policy responses which largely ignore their needs whether by excluding them from targeted COVID-19 mitigation measures, or by imposing restrictions which directly impact on their well-being. Our research with refugee women in Durban, South Africa, illustrates the ways in which COVID-19 has exacerbated their insecurities and intensified structural violence which renders them vulnerable. More importantly, it seems that the impacts of COVID-19 are not just short term but will deepen the violence and insecurities experienced by these women in the longer term if these are not addressed by government and relevant NGOs and civil society organizations.
Collapse
|
5
|
Chareka S, Crankshaw TL, Zambezi P. Economic and social dimensions influencing safety of induced abortions amongst young women who sell sex in Zimbabwe. Sex Reprod Health Matters 2021; 29:1881209. [PMID: 33576331 PMCID: PMC8009027 DOI: 10.1080/26410397.2021.1881209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Globally, women, experience inequities in access to safe abortion services and this is most acutely felt in country contexts where legal abortions are highly restricted. Data around abortion amongst young women who sell sex (YWSS) in sub-Saharan Africa are very limited. We conducted 30 focus group discussions and 42 in-depth interviews (IDIs) amongst YWSS (16–24 years) in urban and peri-urban areas of Zimbabwe, as well as IDIs amongst 16 peer educators, five health care providers and four key informants. Our findings indicate that abortions occur amongst YWSS in Zimbabwe but there remain questions over the extent of safety of abortions. The restrictive legal context around abortion and illegality of sex work in the country are key determinants underlying the clandestine nature of abortions. Socioeconomic concerns are key in decision-making around abortions. Youth, cost and lack of referral networks contribute towards unsafe abortions, even when safe abortion services are available. Many YWSS are not aware of the availability of post abortion care (PAC) services and resort to self-administered PAC. Being young and selling sex combine and interact on the economic and social levels to produce vulnerabilities greater than their sum to experiencing unsafe abortion.
Collapse
Affiliation(s)
- Samantha Chareka
- PhD Candidate, Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa; Family AIDS Caring Trust (FACT), Mutare, Zimbabwe
| | - Tamaryn L Crankshaw
- SRHR Programme Lead and Senior Research Fellow, Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Pemberai Zambezi
- Strategic Information & Research Manager, Family AIDS Caring Trust (FACT), Mutare, Zimbabwe
| |
Collapse
|
6
|
Hikuam F, Crankshaw TL, Sundewall J. Engaging communities: the key to leaving no one behind in the era of UHC. Sex Reprod Health Matters 2020; 28:1849951. [PMID: 33283683 PMCID: PMC7887904 DOI: 10.1080/26410397.2020.1849951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Felicita Hikuam
- Director, AIDS and Rights Alliance for Southern Africa (ARASA), Windhoek, Namibia
| | - Tamaryn L Crankshaw
- SRHR Programme Lead and Senior Research Fellow, Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Jesper Sundewall
- SRHR Programme Lead and Senior Research Fellow, Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa.,Senior Researcher, Division of Social Medicine and Global Health, Lund University, Lund, Sweden
| |
Collapse
|
7
|
Freedman J, Crankshaw TL, Mutambara VM. Sexual and reproductive health of asylum seeking and refugee women in South Africa: understanding the determinants of vulnerability. Sex Reprod Health Matters 2020; 28:1758440. [PMID: 32425112 PMCID: PMC7888032 DOI: 10.1080/26410397.2020.1758440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Women asylum seekers and refugees face huge challenges related to their sexual and reproductive health (SRH) and rights. In this article we explore the structural determinants of vulnerability to poor SRH for these women in South Africa, and focus particularly on the political, legal and economic structures which render them vulnerable. Based on a qualitative study carried out in Durban, South Africa, we argue that it is vital to go beyond analyses which prioritise the socio-cultural barriers to sexual and reproductive health and rights for asylum seekers and refugees, and to consider the wider national and international policies and legislation which create barriers to these women's rights to SRH.
Collapse
Affiliation(s)
- Jane Freedman
- Professor, Centre for Sociological and Political Research (CRESPPA), Université Paris 8 Paris, France
| | - Tamaryn L Crankshaw
- Senior Research Fellow, Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Victoria M Mutambara
- Post-Doctoral Researcher, HEARD, Univerity of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
8
|
Crankshaw TL, Strauss M, Gumede B. Menstrual health management and schooling experience amongst female learners in Gauteng, South Africa: a mixed method study. Reprod Health 2020; 17:48. [PMID: 32293481 PMCID: PMC7158143 DOI: 10.1186/s12978-020-0896-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 03/09/2020] [Indexed: 02/05/2023] Open
Abstract
Background There has been increased attention to the menstrual health management (MHM) needs of girls and young women in Eastern and Southern Africa, relating to dignity, and to the potential link between the lack of access to sanitary products and school absenteeism. In the South Africa, there is inadequate evidence to guide appropriate national responses. This study explored the extent of access to modern sanitary products amongst female high school learners and the range of needs and challenges that they face in managing their menses in school settings in Gauteng, South Africa. Methods We collected mixed method data from 10 schools in Sedibeng district between June and August 2018. The qualitative component consisted of in-depth interviews with female learners (n = 30), educators (n = 8) and mothers of female learners (n = 9) and focus group discussions (FGDs) with male learners (n = 7) and female learners (n = 10). Five hundred and five female learners were recruited into the quantitative component consisting of a self-administered survey focussing on factors associated with access to sanitary products. Results The median age of survey participants was 17 years (interquartile range 16–18 years) and average age at menarche was 13.36 years. One in seven female learners reported not having enough sanitary products for every period in the last 3 months and this was reflected across the school quintiles. There was a complex interaction between menstrual-related challenges (physical discomfort, teasing, and feeling distracted in class) experienced by female learners, often amplified or compounded by factors in the school environment (unhygienic sanitation facilities and inadequate rest areas), and schooling participation and attendance. Girls who did not have enough products for every period in the last 3 months more likely reported missing school than those who reported sufficient products (46.27% vs 22.49% respectively, p < 0.001). However, there was no statistically significant difference between the groups in number of days missed. Conclusions Provision of sanitary products is important but only one component of a comprehensive MHM response. Ongoing attention over the link between product access and absenteeism risks overlooking complex systemic and structural factors which can negatively impact the sexual and reproductive health of learners in the school context, and more broadly.
Collapse
Affiliation(s)
- Tamaryn L Crankshaw
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa.
| | - Michael Strauss
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa
| | - Bongiwe Gumede
- Legal Resources Centre, P.O. Box 9495, Johannesburg, 2000, South Africa
| |
Collapse
|
9
|
Crankshaw TL, Kriel Y, Milford C, Cordero JP, Mosery N, Steyn PS, Smit J. "As we have gathered with a common problem, so we seek a solution": exploring the dynamics of a community dialogue process to encourage community participation in family planning/contraceptive programmes. BMC Health Serv Res 2019; 19:710. [PMID: 31623612 PMCID: PMC6798361 DOI: 10.1186/s12913-019-4490-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 08/28/2019] [Indexed: 11/20/2022] Open
Abstract
Background Community dialogues have been widely used as a method for community engagement and participation to cover a broad range of areas. However, there has been limited documentation and evaluation of the process, particularly as a method towards achieving family planning and contraception (FP/C) programme goals. As part of the development of an intervention package aimed at increasing community and health care provider (HCP) participation in the provision of FP/C, feasibility testing of the intervention approach (a community dialogue between communities and health facilities) was carried out. Our findings offer a systematic description and evaluation of the community dialogue process, with key recommendations towards future implementation. Methods The dialogue was evaluated in three ways: 1) through participant observation during the community dialogue, 2) via a standardised feasibility testing tick-list for all observers of the dialogue, and 3) through three focus group discussions (FGDs) consisting of different groups of stakeholders who participated in the community dialogue. In total, 28 community members, HCPs, and key stakeholders attended the community dialogue (22 females, 6 males). Twenty-seven of the community dialogue participants participated in one of 3 FGDs held after the dialogue. Six evaluators assessed feasibility of the dialogue process. Results There was good attendance, representation and participation amongst community and provider sectors based on the participant observations using the standardized feasibility check-list. The community dialogue process received positive feedback in the FGDs and was demonstrated to be feasible and acceptable. Key factors contributing to the success of the community dialogue included a skilled facilitator, good representation of participants, establishing ground rules, good timekeeping, and using a Theory of Change to facilitate goal identification and dialogue. Issues to consider are the underlying power differentials related to age, profession and gender which caused initial feelings of anxiety amongst some participants. Conclusions Our formative findings offer a systematic description and evaluation of a community dialogue process with key recommendations that may be considered when constituting similar community dialogues in the future. Electronic supplementary material The online version of this article (10.1186/s12913-019-4490-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tamaryn L Crankshaw
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa.
| | - Yolandie Kriel
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Witwatersrand, Durban, South Africa
| | - Cecilia Milford
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Witwatersrand, Durban, South Africa
| | - Joanna Paula Cordero
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training Human Reproduction, Avenue Appia 20, 1202, Geneva, Switzerland
| | - Nzwakie Mosery
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Witwatersrand, Durban, South Africa
| | - Petrus S Steyn
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training Human Reproduction, Avenue Appia 20, 1202, Geneva, Switzerland
| | - Jennifer Smit
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Witwatersrand, Durban, South Africa
| |
Collapse
|
10
|
Aantjes CJ, Gilmoor A, Syurina EV, Crankshaw TL. The status of provision of post abortion care services for women and girls in Eastern and Southern Africa: a systematic review. Contraception 2018; 98:S0010-7824(18)30094-5. [PMID: 29550457 DOI: 10.1016/j.contraception.2018.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 03/04/2018] [Accepted: 03/05/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To conduct a systematic review of the status of post-abortion care (PAC) provision in Eastern and Southern Africa with particular reference to reach, quality and costs of these services. STUDY DESIGN We searched Pubmed, EMBASE, Science Direct, POPLINE and Web of Science for articles published between 2000 and October 2017 presenting primary or secondary data from one or more countries in the region. RESULTS Seventy articles representing data from fourteen countries were abstracted and included in the review. Implementation of PAC services was found to be patchy across countries for which data was available. However, there is evidence of efforts to introduce PAC at lower level health facilities, to use mid-level providers and to employ less invasive medical techniques. Eleven countries from the region were not represented in this review, exposing a considerable knowledge gap over the state of PAC in the region. The disparate access for rural women and girls, the suboptimal service quality and the neglect of adolescent-specific needs were critical gaps in the current PAC provision. CONCLUSION PAC provision and research in this domain cannot be detached from the broader legal and societal context, as social stigma constitutes a major blockage to the advancement of the service. Adolescent girls are a particularly vulnerable and underserved group in the region. IMPLICATIONS The next generation research on PAC should favor multi-country and interdisciplinary study designs with a view to understanding inter-regional differences and supporting advancement towards universal access of PAC by 2030.
Collapse
Affiliation(s)
- Carolien J Aantjes
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban.
| | - Andrew Gilmoor
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Science, Vrije Universiteit Amsterdam
| | - Elena V Syurina
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Science, Vrije Universiteit Amsterdam
| | - Tamaryn L Crankshaw
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban
| |
Collapse
|
11
|
Abstract
Over the past decade, the global response to the HIV epidemic has been unprecedented, and enormous progress has been made. Significant investment in the roll out of antiretroviral treatment (ART) and efforts to increase treatment coverage have greatly reduced the number of AIDS-related deaths worldwide. There are a growing number of promising innovations to expand the HIV prevention mix. However, the reach of these interventions is still very limited in adolescent girls and young women (15-24 years) and the full realisation of the intervention mandates has not yet been achieved. The HIV prevention field has been criticised for the tendency to adopt a narrow focus. The Fast-Track Strategy offers a unique opportunity for the HIV prevention field to broaden its gaze and to begin to identify synergies (and efficiencies) with prevention approaches from other global development priorities, namely sexual and reproductive health and rights (SRHR). This paper applies a SRHR lens to HIV prevention by highlighting the critical relationship between unintended pregnancy and HIV, and seeks to expand on earlier debates that prevention of HIV and prevention of unintended pregnancy are inextricably linked, complementary activities with interrelated and common goals. We call for the prioritisation of prevention of unintended pregnancy amongst two overlapping population groups - girls and young women (15-24 years old) and women living with HIV - as a key tactic to accomplish the Joint United Nations Programme on HIV/AIDS (UNAIDS) Fast-Track Strategy and as a way to fully realise existing HIV prevention efforts. We discuss the intersecting pathways between HIV prevention and unintended pregnancy prevention and build a case for contraception to be placed at the centre of the HIV prevention agenda.
Collapse
Affiliation(s)
- Tamaryn L Crankshaw
- a Health Economics and HIV and AIDS Research Division (HEARD) , University of KwaZulu-Natal , Durban , South Africa
| | - Jennifer A Smit
- b MatCH Research (Maternal, Adolescent, & Child Health Research) Unit, Department of Obstetrics and Gynaecology , Faculty of Health Sciences , University of the Witwatersrand , South Africa
| | - Mags E Beksinska
- b MatCH Research (Maternal, Adolescent, & Child Health Research) Unit, Department of Obstetrics and Gynaecology , Faculty of Health Sciences , University of the Witwatersrand , South Africa
| |
Collapse
|
12
|
Katz IT, Butler LM, Crankshaw TL, Wright AA, Bramhill K, Leone DA, Giddy J, Mould S. Cervical Abnormalities in South African Women Living With HIV With High Screening and Referral Rates. J Glob Oncol 2016; 2:375-380. [PMID: 28717723 PMCID: PMC5493244 DOI: 10.1200/jgo.2015.002469] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To determine the prevalence of screening, cervical dysplasia, and malignancy on the basis of histologic diagnoses from colposcopy and large loop excision of the transformation zone among women living with HIV (WLWH) who attended an urban antiretroviral treatment (ART) clinic in KwaZulu-Natal, South Africa. MATERIALS AND METHODS We performed a retrospective cohort study to examine a random sample of 462 WLWH during a 5-year period from 2004 to 2009. Women on ART for < 3 months were excluded. Data were abstracted from electronic records and paper charts to assess rates of cervical abnormalities detected on Pap smears as well as time to colposcopy. RESULTS During the study period, 432 women (93.5%) had at least one evaluable Papanicolau test. At baseline, 237 women (54.9%) had an abnormal Papanicolau test, and of these patients, 181 (76.3%) had a Papanicolau test that qualified for further colposcopic evaluation. In addition, 115 women (63.5%) received colposcopy within a median of 39 days from referral. This yielded 74 evaluable histologic samples (64.3%), of which 21.6%, 27.0%, 27.0%, and 1.4% had cervical intraepithelial neoplasia (CIN) 1, CIN2, CIN3, and invasive cervical cancer, respectively. CONCLUSION In a large sample of WLWH who received ART in KwaZulu-Natal, South Africa, where Papanicolau test coverage and rates of referral for colposcopy and large loop excision of the transformation zone were high, > 75% of women with evaluable histologic samples had evidence of cervical dysplasia or malignancy. These findings underscore the importance of routine cervical screening upon entry into HIV care to optimize survival.
Collapse
Affiliation(s)
- Ingrid T. Katz
- Ingrid T. Katz and Dominick A. Leone, Brigham and Women’s Hospital; Ingrid T. Katz, Lisa M. Butler, and Alexi A. Wright, Harvard Medical School; Ingrid T. Katz, Massachusetts General Hospital Center for Global Health; Lisa M. Butler, Boston Children’s Hospital; Alexi A. Wright, Dana-Farber Cancer Institute; Dominick A. Leone, Boston University, Boston, MA; Tamaryn L. Crankshaw, University of KwaZulu-Natal, Durban; Janet Giddy, Western Cape Province Department of Health, Cape Town; Sean Mould, R.K. Khan Hospital, Chatsworth, South Africa; and Karen Bramhill, Canadian Red Cross, Ontario, Canada
| | - Lisa M. Butler
- Ingrid T. Katz and Dominick A. Leone, Brigham and Women’s Hospital; Ingrid T. Katz, Lisa M. Butler, and Alexi A. Wright, Harvard Medical School; Ingrid T. Katz, Massachusetts General Hospital Center for Global Health; Lisa M. Butler, Boston Children’s Hospital; Alexi A. Wright, Dana-Farber Cancer Institute; Dominick A. Leone, Boston University, Boston, MA; Tamaryn L. Crankshaw, University of KwaZulu-Natal, Durban; Janet Giddy, Western Cape Province Department of Health, Cape Town; Sean Mould, R.K. Khan Hospital, Chatsworth, South Africa; and Karen Bramhill, Canadian Red Cross, Ontario, Canada
| | - Tamaryn L. Crankshaw
- Ingrid T. Katz and Dominick A. Leone, Brigham and Women’s Hospital; Ingrid T. Katz, Lisa M. Butler, and Alexi A. Wright, Harvard Medical School; Ingrid T. Katz, Massachusetts General Hospital Center for Global Health; Lisa M. Butler, Boston Children’s Hospital; Alexi A. Wright, Dana-Farber Cancer Institute; Dominick A. Leone, Boston University, Boston, MA; Tamaryn L. Crankshaw, University of KwaZulu-Natal, Durban; Janet Giddy, Western Cape Province Department of Health, Cape Town; Sean Mould, R.K. Khan Hospital, Chatsworth, South Africa; and Karen Bramhill, Canadian Red Cross, Ontario, Canada
| | - Alexi A. Wright
- Ingrid T. Katz and Dominick A. Leone, Brigham and Women’s Hospital; Ingrid T. Katz, Lisa M. Butler, and Alexi A. Wright, Harvard Medical School; Ingrid T. Katz, Massachusetts General Hospital Center for Global Health; Lisa M. Butler, Boston Children’s Hospital; Alexi A. Wright, Dana-Farber Cancer Institute; Dominick A. Leone, Boston University, Boston, MA; Tamaryn L. Crankshaw, University of KwaZulu-Natal, Durban; Janet Giddy, Western Cape Province Department of Health, Cape Town; Sean Mould, R.K. Khan Hospital, Chatsworth, South Africa; and Karen Bramhill, Canadian Red Cross, Ontario, Canada
| | - Karen Bramhill
- Ingrid T. Katz and Dominick A. Leone, Brigham and Women’s Hospital; Ingrid T. Katz, Lisa M. Butler, and Alexi A. Wright, Harvard Medical School; Ingrid T. Katz, Massachusetts General Hospital Center for Global Health; Lisa M. Butler, Boston Children’s Hospital; Alexi A. Wright, Dana-Farber Cancer Institute; Dominick A. Leone, Boston University, Boston, MA; Tamaryn L. Crankshaw, University of KwaZulu-Natal, Durban; Janet Giddy, Western Cape Province Department of Health, Cape Town; Sean Mould, R.K. Khan Hospital, Chatsworth, South Africa; and Karen Bramhill, Canadian Red Cross, Ontario, Canada
| | - Dominick A. Leone
- Ingrid T. Katz and Dominick A. Leone, Brigham and Women’s Hospital; Ingrid T. Katz, Lisa M. Butler, and Alexi A. Wright, Harvard Medical School; Ingrid T. Katz, Massachusetts General Hospital Center for Global Health; Lisa M. Butler, Boston Children’s Hospital; Alexi A. Wright, Dana-Farber Cancer Institute; Dominick A. Leone, Boston University, Boston, MA; Tamaryn L. Crankshaw, University of KwaZulu-Natal, Durban; Janet Giddy, Western Cape Province Department of Health, Cape Town; Sean Mould, R.K. Khan Hospital, Chatsworth, South Africa; and Karen Bramhill, Canadian Red Cross, Ontario, Canada
| | - Janet Giddy
- Ingrid T. Katz and Dominick A. Leone, Brigham and Women’s Hospital; Ingrid T. Katz, Lisa M. Butler, and Alexi A. Wright, Harvard Medical School; Ingrid T. Katz, Massachusetts General Hospital Center for Global Health; Lisa M. Butler, Boston Children’s Hospital; Alexi A. Wright, Dana-Farber Cancer Institute; Dominick A. Leone, Boston University, Boston, MA; Tamaryn L. Crankshaw, University of KwaZulu-Natal, Durban; Janet Giddy, Western Cape Province Department of Health, Cape Town; Sean Mould, R.K. Khan Hospital, Chatsworth, South Africa; and Karen Bramhill, Canadian Red Cross, Ontario, Canada
| | - Sean Mould
- Ingrid T. Katz and Dominick A. Leone, Brigham and Women’s Hospital; Ingrid T. Katz, Lisa M. Butler, and Alexi A. Wright, Harvard Medical School; Ingrid T. Katz, Massachusetts General Hospital Center for Global Health; Lisa M. Butler, Boston Children’s Hospital; Alexi A. Wright, Dana-Farber Cancer Institute; Dominick A. Leone, Boston University, Boston, MA; Tamaryn L. Crankshaw, University of KwaZulu-Natal, Durban; Janet Giddy, Western Cape Province Department of Health, Cape Town; Sean Mould, R.K. Khan Hospital, Chatsworth, South Africa; and Karen Bramhill, Canadian Red Cross, Ontario, Canada
| |
Collapse
|
13
|
Birdsey G, Crankshaw TL, Mould S, Ramklass SS. Unmet counselling need amongst women accessing an induced abortion service in KwaZulu-Natal, South Africa. Contraception 2016; 94:473-477. [DOI: 10.1016/j.contraception.2016.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 06/21/2016] [Accepted: 07/01/2016] [Indexed: 10/21/2022]
|
14
|
Crankshaw TL, Voce A, Butler LM, Darbes L. Expanding the relationship context for couple-based HIV prevention: Elucidating women's perspectives on non-traditional sexual partnerships. Soc Sci Med 2016; 166:169-176. [PMID: 27566046 DOI: 10.1016/j.socscimed.2016.08.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 07/17/2016] [Accepted: 08/12/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION HIV prevention interventions targeting couples are efficacious, cost-effective and a key strategy for preventing HIV transmission. Awareness of the full spectrum of relationship types and underlying complexities, as well as available support mechanisms in a given context, are critical to the design of effective couple-based interventions. OBJECTIVE This paper is based on a sub-analysis of a qualitative research study investigating HIV disclosure dynamics amongst pregnant women living with HIV in Durban, South Africa. The sub-analysis explored the nature of participants' social and relationship contexts and consequences of these dynamics on women's feelings of trust towards partners and perceptions of partner commitment. METHODS Between June and August 2008, we conducted in-depth interviews with 62 pregnant women living with HIV and accessing Prevention of Mother-to-Child Transmission (PMTCT) services in Durban, South Africa. Transcripts were coded for emergent themes and categories using a grounded theoretical approach. RESULTS The median age of participants was 26 years (interquartile range: 22-29 years). Three major themes with accompanying sub themes were identified: 1) relationship types (sub themes included unmarried status, minimal cohabitation with partners, presence of concurrent relationships), 2) relationship quality/functioning (sub themes included low trust and expectation of partner commitment, relationship turbulence, and lack of communication/ability to negotiate protective behaviours), and 3) factors underlying the relationship functioning (sub themes included dynamics of concurrent relationships coinciding with concurrent pregnancies, gender roles and unequal relationship power, intimate partner violence or threat thereof, and lack of social support). CONCLUSIONS Our research findings indicate a lack of many of the dyadic relationship elements underlying couple-counselling frameworks for successful risk reduction coordination. Understanding sexual behaviour and the accompanying relationship dynamics within different types of partnerships is crucial for the optimal design of couple-based HIV prevention interventions.
Collapse
Affiliation(s)
- T L Crankshaw
- Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal 236 George Campbell Building, Howard College Campus, King George V Avenue, Durban 4041, South Africa; Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban 4000, South Africa.
| | - A Voce
- Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal 236 George Campbell Building, Howard College Campus, King George V Avenue, Durban 4041, South Africa
| | - L M Butler
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT 06269-1248, USA
| | - L Darbes
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 N. Ingalls, Ann Arbor, MI 48109, USA
| |
Collapse
|
15
|
Mindry DL, Milford C, Greener L, Greener RM, Maharaj P, Letsoalo T, Munthree C, Crankshaw TL, Smit JA. Client and provider knowledge and views on safer conception for people living with HIV (PLHIV). Sex Reprod Healthc 2016; 10:35-40. [PMID: 27938871 DOI: 10.1016/j.srhc.2016.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 03/22/2016] [Accepted: 03/28/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE(S) The childbearing needs of people living with HIV (PLHIV) and the experiences of healthcare providers serving them are explored. We examine provider and client knowledge and views on safer conception methods. METHODS The study uses exploratory qualitative research to understand provider and client perspectives on childbearing and safer conception. Interviews were conducted at 3 sites (1 rural, 2 urban) in eThekwini District, KwaZulu-Natal, South Africa between May 2011 and August 2012, including in-depth interviews with 43 PLHIV, 2 focus group discussions and 12 in-depth interviews with providers. RESULTS Clients had little knowledge and providers had limited knowledge of safer conception methods. While clients were eager to receive counseling on safer conception, providers had some hesitations but were eager to receive training in delivering safer conception services. Clients and providers noted that biological parentage is a major concern of PLHIV. Clients were willing to use any of the described methods to have biological children but some expressed concerns about potential risks associated with timed unprotected intercourse. Male clients required access to reproductive health information. CONCLUSIONS Providers need to routinely initiate discussions with clients about childbearing intentions. Providers need to be enabled with approved guidelines and training to support client access to safer conception methods.
Collapse
Affiliation(s)
- Deborah L Mindry
- Center for Culture and Health, Semel Institute, University of California, Los Angeles, USA.
| | - Cecilia Milford
- MatCH Research (Maternal, Adolescent and Child Health), Dept. of Obstetrics and Gynecology, Faculty of Health Sciences, University of Witwatersrand, Durban, South Africa
| | - Letitia Greener
- MatCH Research (Maternal, Adolescent and Child Health), Dept. of Obstetrics and Gynecology, Faculty of Health Sciences, University of Witwatersrand, Durban, South Africa
| | - Ross M Greener
- MatCH Research (Maternal, Adolescent and Child Health), Dept. of Obstetrics and Gynecology, Faculty of Health Sciences, University of Witwatersrand, Durban, South Africa
| | - Pranitha Maharaj
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Thabo Letsoalo
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Chantal Munthree
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Tamaryn L Crankshaw
- Health Economics HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Jennifer A Smit
- MatCH Research (Maternal, Adolescent and Child Health), Dept. of Obstetrics and Gynecology, Faculty of Health Sciences, University of Witwatersrand, Durban, South Africa; School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
16
|
Matthews LT, Smit JA, Moore L, Milford C, Greener R, Mosery FN, Ribaudo H, Bennett K, Crankshaw TL, Kaida A, Psaros C, Safren SA, Bangsberg DR. Periconception HIV Risk Behavior Among Men and Women Reporting HIV-Serodiscordant Partners in KwaZulu-Natal, South Africa. AIDS Behav 2015; 19:2291-303. [PMID: 26080688 PMCID: PMC4926315 DOI: 10.1007/s10461-015-1050-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
HIV-infected men and women who choose to conceive risk infecting their partners. To inform safer conception programs we surveyed HIV risk behavior prior to recent pregnancy amongst South African, HIV-infected women (N = 209) and men (N = 82) recruited from antenatal and antiretroviral clinics, respectively, and reporting an uninfected or unknown-HIV-serostatus pregnancy partner. All participants knew their HIV-positive serostatus prior to the referent pregnancy. Only 11 % of women and 5 % of men had planned the pregnancy; 40 % of women and 27 % of men reported serostatus disclosure to their partner before conception. Knowledge of safer conception strategies was low. Around two-thirds reported consistent condom use, 41 % of women and 88 % of men reported antiretroviral therapy, and a third of women reported male partner circumcision prior to the referent pregnancy. Seven women (3 %) and two men (2 %) reported limiting sex without condoms to peak fertility. None reported sperm washing or manual insemination. Safer conception behaviors including HIV-serostatus disclosure, condom use, and ART at the time of conception were not associated with desired pregnancy. In light of low pregnancy planning and HIV-serostatus disclosure, interventions to improve understandings of serodiscordance and motivate mutual HIV-serostatus disclosure and pregnancy planning are necessary first steps before couples or individuals can implement specific safer conception strategies.
Collapse
Affiliation(s)
- L T Matthews
- Division of Infectious Disease and Center for Global Health, Massachusetts General Hospital, 100 Cambridge Street, 15th Floor, Boston, MA, 02114, USA.
| | - J A Smit
- MatCH Research [Maternal, Adolescent and Child Health Research], Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
- School of Pharmacy and Pharmacology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - L Moore
- MatCH Research [Maternal, Adolescent and Child Health Research], Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - C Milford
- MatCH Research [Maternal, Adolescent and Child Health Research], Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - R Greener
- MatCH Research [Maternal, Adolescent and Child Health Research], Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - F N Mosery
- MatCH Research [Maternal, Adolescent and Child Health Research], Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - H Ribaudo
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA, USA
| | - K Bennett
- Bennett Statistical Consulting, Inc., Ballston Lake, NY, USA
| | - T L Crankshaw
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - A Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - C Psaros
- Behavioral Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - S A Safren
- Behavioral Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - D R Bangsberg
- Division of Infectious Disease and Center for Global Health, Massachusetts General Hospital, 100 Cambridge Street, 15th Floor, Boston, MA, 02114, USA
| |
Collapse
|
17
|
Katz IT, Bogart LM, Cloete C, Crankshaw TL, Giddy J, Govender T, Gaynes MR, Leone D, Losina E, Bassett IV. Understanding HIV-infected patients' experiences with PEPFAR-associated transitions at a Centre of Excellence in KwaZulu Natal, South Africa: a qualitative study. AIDS Care 2015; 27:1298-303. [PMID: 26300297 PMCID: PMC4548805 DOI: 10.1080/09540121.2015.1051502] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
South Africa was the largest recipient of funding from the President's Emergency Plan for AIDS Relief (PEPFAR) for antiretroviral therapy (ART) programs from 2004 to 2012. Funding decreases have led to transfers from hospital and non-governmental organization-based care to government-funded, community-based clinics. We conducted semi-structured interviews with 36 participants to assess patient experiences related to transfer of care from a PEPFAR-funded, hospital-based clinic in Durban to either primary care clinics or hospital-based clinics. Participant narratives revealed the importance of connectedness between patients and the PEPFAR-funded clinic program staff, who were described as respectful and conscientious. Participants reported that transfer clinics were largely focused on dispensing medication and on throughput, rather than holistic care. Although participants appreciated the free treatment at transfer sites, they expressed frustration with long waiting times and low perceived quality of patient-provider communication, and felt that they were treated disrespectfully. These factors eroded confidence in the quality of the care. The transfer was described by participants as hurried with an apparent lack of preparation at transfer clinics for new patient influx. Formal (e.g., counseling) and informal (e.g., family) social supports, both within and beyond the PEPFAR-funded clinic, provided a buffer to challenges faced during and after the transition in care. These data support the importance of social support, adequate preparation for transfer, and improving the quality of care in receiving clinics, in order to optimize retention in care and long-term adherence to treatment.
Collapse
Affiliation(s)
- Ingrid T Katz
- Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Massachusetts General Hospital Center for Global Health, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Laura M Bogart
- Harvard Medical School, Boston, Massachusetts, United States of America
- Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts, United States of America
| | | | - Tamaryn L Crankshaw
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | | | | | - Melanie R Gaynes
- Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Dominick Leone
- Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Elena Losina
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts, United States of America
- Division of Rheumatology, Department of Medicine, and Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Ingrid V Bassett
- Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard University Center for AIDS Research (CFAR), Boston, Massachusetts, United States of America
- Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| |
Collapse
|
18
|
Mindry DL, Crankshaw TL, Maharaj P, Munthree C, Letsoalo T, Milford C, Greener RM, Rambally L, Carpenter S, Smit JA. "We have to try and have this child before it is too late": missed opportunities in client-provider communication on reproductive intentions of people living with HIV. AIDS Care 2014; 27:25-30. [PMID: 25202986 DOI: 10.1080/09540121.2014.951311] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Men and women living with HIV with access to ARVs are living longer, healthier lives that can and often do include bearing children. Children occupy a key space in men and women's personal and social lives and often play a fundamental role in maintaining these relationships, irrespective of illness concerns. Couples living with HIV need to balance prevention needs and ill-health while trying to maintain healthy relationships. Health-care providers serving the reproductive needs of HIV-affected couples need to consider the social and relational factors shaping reproductive decisions associated with periconception risk behaviors. This paper based on qualitative research at three hospital sites in eThekwini District, South Africa, investigates the childbearing intentions and needs of people living with HIV (PLHIV), and the attitudes and experiences of health-care providers serving the reproductive needs of PLHIV, and client and provider views and knowledge of safer conception. This research revealed that personal, social, and relationship dynamics shape the reproductive decisions of PLHIV, and "unplanned" pregnancies are not always unintended. Additionally, conception desires are not driven by the number of living children; rather clients are motivated by whether or not they have had any children with their current partner/spouse. Providers should consider the relationship status of clients in discussions about childbearing desires and intentions. Although many providers recognize the complex social realities shaping their clients' reproductive decisions, they have outdated information on serving their reproductive needs. Appropriate training to enable providers to better understand the relationship and social realities surrounding their clients' childbearing intentions is required and should be used as a platform for couples to work together with providers toward safer conception. The adoption of a more participatory approach should be employed to equalize client-provider power dynamics and to ensure clients are more involved in decision-making about reproduction and conception.
Collapse
Affiliation(s)
- D L Mindry
- a Center for Culture and Health , Semel Institute, University of California , Los Angeles , CA , USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Matthews LT, Moore L, Crankshaw TL, Milford C, Mosery FN, Greener R, Psaros C, Safren SA, Bangsberg DR, Smit JA. South Africans with recent pregnancy rarely know partner's HIV serostatus: implications for serodiscordant couples interventions. BMC Public Health 2014; 14:843. [PMID: 25124267 PMCID: PMC4246447 DOI: 10.1186/1471-2458-14-843] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 07/24/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Implementation of safer conception strategies requires knowledge of partner HIV-serostatus. We recruited women and men in a high HIV-prevalence setting for a study to assess periconception risk behavior among individuals reporting HIV-serodiscordant partnerships. We report screening data from that study with the objective of estimating the proportion of individuals who are aware that they are in an HIV-serodiscordant relationship at the time of conception. METHODS We screened women and men attending antenatal and antiretroviral clinics in Durban, South Africa for enrollment in a study of periconception risk behavior among individuals with serodiscordant partners. Screening questionnaires assessed for study eligibility including age 18-45 years (for women) or at least 18 years of age (for men), pregnancy in past year (women) or partner pregnancy in the past 3 years (men), HIV status of partner for recent pregnancy, participant's HIV status, and infected partner's HIV status having been known before the referent pregnancy. RESULTS Among 2620 women screened, 2344 (90%) met age and pregnancy criteria and knew who fathered the referent pregnancy. Among those women, 963 (41%) did not know the pregnancy partner's HIV serostatus at time of screening. Only 92 (4%) reported knowing of a serodiscordant partnership prior to pregnancy. Among 1166 men screened, 225 (19%) met age and pregnancy criteria. Among those men, 71 (32%) did not know the pregnancy partner's HIV status and only 30 (13%) reported knowing of a serodiscordant partnership prior to pregnancy. CONCLUSIONS In an HIV-endemic setting, awareness of partner HIV serostatus is rare. Innovative strategies to increase HIV testing and disclosure are required to facilitate HIV prevention interventions for serodiscordant couples.
Collapse
Affiliation(s)
- Lynn T Matthews
- />Division of Infectious Disease and Center for Global Health, Massachusetts General Hospital, 100 Cambridge Street, 15th Floor, Boston, MA 02114 USA
- />Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, USA
| | - Lizzie Moore
- />Maternal, Adolescent and Child Health (MatCH), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Tamaryn L Crankshaw
- />Health Economics and HIV and AIDS Research Division, University of Kwazulu-Natal, Durban, South Africa
| | - Cecilia Milford
- />Maternal, Adolescent and Child Health (MatCH), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Fortunate N Mosery
- />Maternal, Adolescent and Child Health (MatCH), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Ross Greener
- />Maternal, Adolescent and Child Health (MatCH), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Christina Psaros
- />Department of Psychiatry, Massachusetts General Hospital, Boston, USA
| | - Steven A Safren
- />Department of Psychiatry, Massachusetts General Hospital, Boston, USA
| | - David R Bangsberg
- />Division of Infectious Disease and Center for Global Health, Massachusetts General Hospital, 100 Cambridge Street, 15th Floor, Boston, MA 02114 USA
| | - Jennifer A Smit
- />Maternal, Adolescent and Child Health (MatCH), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| |
Collapse
|
20
|
Crankshaw TL, Voce A, King RL, Giddy J, Sheon NM, Butler LM. Double disclosure bind: complexities of communicating an HIV diagnosis in the context of unintended pregnancy in Durban, South Africa. AIDS Behav 2014; 18 Suppl 1:S53-9. [PMID: 23722975 DOI: 10.1007/s10461-013-0521-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Disclosure of HIV status is widely promoted in the prevention of mother-to-child transmission (PMTCT), but a number of context-specific factors may mediate disclosure outcomes. To better understand HIV-disclosure dynamics, we conducted in-depth interviews among 62 HIV-positive pregnant women accessing PMTCT services in Durban, South Africa. Transcripts were coded for emergent themes and categories. Thirty-nine women (63 %) had been recently diagnosed with HIV; most (n = 37; 95 %) were diagnosed following routine antenatal HIV testing. Forty-two women (68 %) reported unplanned pregnancies. Overall, 37 women (60 %) reported an unintended pregnancy and recent HIV diagnosis. For them, 2 life-changing diagnoses had resulted in a double-disclosure bind. The timing and stigma surrounding these events strongly influenced disclosure of pregnancy and/or HIV. PMTCT-related counseling must be responsive to the complex personal implications of contemporaneous, life-changing events, especially their effect on HIV-disclosure dynamics and, ultimately, on achieving better maternal mental-health outcomes.
Collapse
Affiliation(s)
- Tamaryn L Crankshaw
- Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa,
| | | | | | | | | | | |
Collapse
|
21
|
Crankshaw TL, Matthews LT, Giddy J, Kaida A, Ware NC, Smit JA, Bangsberg DR. A conceptual framework for understanding HIV risk behavior in the context of supporting fertility goals among HIV-serodiscordant couples. Reprod Health Matters 2012; 20:50-60. [PMID: 23177680 PMCID: PMC3608509 DOI: 10.1016/s0968-8080(12)39639-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Integrated reproductive health services for people living with HIV must address their fertility intentions. For HIV-serodiscordant couples who want to conceive, attempted conception confers a substantial risk of HIV transmission to the uninfected partner. Behavioral and pharmacologic strategies may reduce HIV transmission risk among HIV-serodiscordant couples who seek to conceive. In order to develop effective pharmaco-behavioral programs, it is important to understand and address the contexts surrounding reproductive decision-making; perceived periconception HIV transmission risk; and periconception risk behaviors. We present a conceptual framework to describe the dynamics involved in periconception HIV risk behaviors in a South African setting. We adapt the Information-Motivation-Behavioral Skill Model of HIV Preventative Behavior to address the structural, individual and couple-level determinants of safer conception behavior. The framework is intended to identify factors that influence periconception HIV risk behavior among serodiscordant couples, and therefore to guide design and implementation of integrated and effective HIV, reproductive health and family planning services that support reproductive decision-making.
Collapse
|
22
|
Chetty T, Knight S, Giddy J, Crankshaw TL, Butler LM, Newell ML. A retrospective study of Human Immunodeficiency Virus transmission, mortality and loss to follow-up among infants in the first 18 months of life in a prevention of mother-to-child transmission programme in an urban hospital in KwaZulu-Natal, South Africa. BMC Pediatr 2012; 12:146. [PMID: 22963527 PMCID: PMC3468389 DOI: 10.1186/1471-2431-12-146] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 08/31/2012] [Indexed: 11/08/2022] Open
Abstract
Background Follow up of Human Immunodeficiency Virus (HIV)-exposed infants is an important component of Prevention of Mother-to-Child Transmission (PMTCT) programmes in order to ascertain infant outcomes post delivery. We determined HIV transmission, mortality and loss to follow-up (LTFU) of HIV-exposed infants attending a postnatal clinic in an urban hospital in Durban, South Africa. Methods We conducted a retrospective cohort study of infants born to women in the PMTCT programme at McCord Hospital, where mothers paid a fee for service. Data were abstracted from patient records for live-born infants delivered between 1 May 2008 and 31 May 2009. The infants’ LTFU status and age was based on the date of the last visit. HIV transmission was calculated as a proportion of infants followed and tested at six weeks. Mortality rates were analyzed using Kaplan-Meier (K-M), with censoring on 15 January 2010, LTFU or death. Results Of 260 infants, 155 (59.6%) remained in care at McCord beyond 28 weeks: one died at < 28 days, three died between one to six months; 34 were LTFU within seven days, 60 were LTFU by six months. K-M mortality rate: 1.7% at six months (95% confidence interval (CI): 0.6% to 4.3%). Of 220 (83%) infants tested for HIV at six weeks, six (2.7%, 95% CI: 1.1% to 5.8%) were HIV-infected. In Cox regression analysis, late antenatal attendance (≥ 28 weeks gestation) relative to attending in the first trimester was a predictor for infant LTFU (adjusted hazards ratio = 2.3; 95% CI: 1.0 to 5.1; p = 0.044). Conclusion This urban PMTCT programme achieved low transmission rates at six weeks, but LTFU in the first six months limited our ability to examine HIV transmission up to 18 months and determinants of mortality. The LTFU of infants born to women who attended antenatal care at 28 weeks gestation or later emphasizes the need to identify late antenatal attendees for follow up care to educate and support them regarding the importance of follow up care for themselves and their infants.
Collapse
Affiliation(s)
- Terusha Chetty
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa.
| | | | | | | | | | | |
Collapse
|