Fertility intentions of women living with HIV and their male partners during the perinatal period in rural South Africa

2021 ◽  
pp. 095646242098744
Author(s):  
Lissa N Mandell ◽  
Violeta J Rodriguez ◽  
Karl Peltzer ◽  
Stephen M Weiss ◽  
Deborah L Jones
Keyword(s):  
South Africa ◽  
Perinatal Care ◽  
Healthcare Providers ◽  
Male Involvement ◽  
Fertility Intentions ◽  
People Living With Hiv ◽  
Male Partners ◽  
Safer Conception ◽  
Women Living With Hiv ◽  
Living With Hiv

Understanding the fertility intentions of people living with HIV can guide safer conception planning and prevention of mother-to-child transmission (PMTCT). Most research has addressed fertility intentions among women, rather than couples, at a single time point. This clinical trial of a PMTCT intervention in rural Mpumalanga province, South Africa, examined longitudinal fertility intentions among perinatal women living with HIV and their male partners. Study assessments and intervention and control sessions were conducted prenatally and postpartum. Longitudinal predictors of participants’ ( n = 360 men, n = 917 women) fertility intentions were similar between sexes. Younger age and male involvement in perinatal care were associated with reporting fertility intentions at both baseline and 12 months postpartum. Having an HIV-positive infant and discussing pregnancy plans with a healthcare provider by 12 months postpartum were associated with incident fertility intentions after reporting no plans for further children at baseline. Results highlight the important role of healthcare providers to educate men and women on issues surrounding conception, as well as the potential for incorporating PMTCT and safer conception education into HIV clinical services.

scholarly journals “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

2020 ◽  
Vol 1 ◽  
Author(s):  
Sarah A. Gutin ◽  
Gary W. Harper ◽  
Neo Moshashane ◽  
Christina Bitsang ◽  
Jane Harries ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Safer Conception ◽  
Knowledge Practices ◽  
Women Living With Hiv ◽  
Universal Test And Treat ◽  
Living With Hiv ◽  
And Training

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.

scholarly journals Prevalence and Correlates of Snuff Use, and its Association With Tuberculosis, Among Women Living With HIV in South Africa

2018 ◽  
Vol 21 (8) ◽  
pp. 1087-1092 ◽  
Author(s):  
Jessica L Elf ◽  
Ebrahim Variava ◽  
Sandy Chon ◽  
Limakatso Lebina ◽  
Katlego Motlhaoleng ◽  
...  
Keyword(s):  
South Africa ◽  
Tobacco Use ◽  
Smokeless Tobacco ◽  
People Living With Hiv ◽  
Potential Health ◽  
Adjusted Analysis ◽  
Women Living With Hiv ◽  
Urine Cotinine ◽  
Smokeless Tobacco Use ◽  
Living With Hiv

Abstract Introduction A higher proportion of people living with HIV (PLWH) smoke compared to the general population, but little information exists about the prevalence and correlates of smokeless tobacco use among PLWH. In South Africa, dry powdered tobacco is inhaled nasally as snuff. Methods A cross-sectional survey among PLWH attending three HIV clinics was conducted. Snuff use was assessed via self-report and urine cotinine. Results Given the low (3%) prevalence of snuff use among men, analysis was restricted to n = 606 nonsmoking women living with HIV. Half (n = 298, 49%) were snuff users, the majority of whom (n = 244, 84%) had a positive urine cotinine test. In adjusted analysis, snuff use was negatively associated with higher education (relative risk [RR] 0.55; 95% confidence interval [CI]: 0.39, 0.77) and mobile phone ownership (RR 0.83; 95% CI: 0.71, 0.98), and positively associated with ever having tuberculosis (TB) (RR 1.22; 95% CI: 1.03, 1.45). In adjusted analysis, with current TB as the outcome, snuff use was marginally statistically significantly associated with a twofold increase in odds of a current TB diagnosis (odds ratio [OR] 1.99; 95% CI: 0.98, 4.15). Discussion A high proportion of nonsmoking South African women living with HIV use snuff, which was a risk factor for TB. Additional research is needed to understand the relationship between snuff, TB, and other potential health risks. Implications PLWH have a higher prevalence of smoking than their seronegative peers, but there is a paucity of research on smokeless tobacco use in this population, especially in low-resource settings. TB is the leading cause of death among PLWH, and with improvements to HIV treatment and care, PLWH are at greater risk of tobacco-related diseases. We report an extremely high prevalence of snuff use among women living with HIV in South Africa. Further, in this population snuff use is positively associated with ever having a TB diagnosis, as well as currently having TB.

scholarly journals Fertility Intentions and Interest in Integrated Family Planning Services among Women Living with HIV in Nyanza Province, Kenya: A Qualitative Study

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Elizabeth K. Harrington ◽  
Sara J. Newmann ◽  
Maricianah Onono ◽  
Katie D. Schwartz ◽  
Elizabeth A. Bukusi ◽  
...  
Keyword(s):  
Family Planning ◽  
Unmet Need ◽  
Fertility Intentions ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Theory Approach ◽  
Unintended Pregnancies ◽  
Women Living With Hiv ◽  
Perinatal Hiv ◽  
Living With Hiv

Despite increasing efforts to address the reproductive health needs of people living with HIV, a high unmet need for contraception exists among HIV+ women in sub-Saharan Africa. This study explores the fertility intentions and family planning (FP) preferences of Kenyan women accessing HIV treatment. We conducted 30 semistructured interviews and qualitatively analyzed the data with a grounded theory approach. Fears of premature death, financial hardship, and perinatal HIV transmission emerged as reasons for participants’ desire to delay/cease childbearing. Participants strongly identified FP needs, yet two-thirds were using male condoms alone or no modern method of contraception. Women preferred the HIV clinic as the site of FP access for reasons of convenience, provider expertise, and a sense of belonging, though some had privacy concerns. Our findings support the acceptability of integrated FP and HIV services. Efforts to empower women living with HIV to prevent unintended pregnancies must expand access to contraceptive methods, provide confidential services, and take into account women's varied reproductive intentions.

scholarly journals Fertility Intentions and Clinical Care Attendance Among Women Living with HIV in South Africa

2019 ◽  
Vol 24 (6) ◽  
pp. 1585-1591 ◽  
Author(s):  
Katherine B. Rucinski ◽  
Sheree R. Schwartz ◽  
Kimberly A. Powers ◽  
Brian W. Pence ◽  
Benjamin H. Chi ◽  
...  
Keyword(s):  
South Africa ◽  
Clinical Care ◽  
Fertility Intentions ◽  
Women Living With Hiv ◽  
Living With Hiv

scholarly journals Fertility desires of people living with HIV: Does the implementation of a sexual and reproductive health and HIV integration model change healthcare providers’ attitudes and clients’ desires?

2020 ◽  
Author(s):  
Cecilia Milford ◽  
Mags Beksinska ◽  
Ross Greener ◽  
Jacqueline Pienaar ◽  
Letitia Rambally Greener ◽  
...  
Keyword(s):  
Reproductive Health ◽  
Sexual And Reproductive Health ◽  
Healthcare Providers ◽  
People Living With Hiv ◽  
Safer Conception ◽  
Cross Sectional Survey ◽  
Integration Model ◽  
Fertility Desires ◽  
Integration Of Services ◽  
Living With Hiv

Abstract Background There is a need for information and healthcare support for fertility desires and contraceptive needs of people living with HIV (PLHIV), and to provide safer conception support for sero-discordant couples wanting to conceive. A model to integrate sexual and reproductive health and HIV services was developed and implemented in a district hospital and six clinics in eThekwini District, South Africa. Methods To evaluate the model’s success, a cross-sectional survey was conducted before and after implementation. As part of this evaluation, fertility desires of PLHIV (both male and female), and providers’ perspectives thereof were explored. Changes in desires and attitudes after integration of services were investigated. Results Forty-six healthcare providers and 269 clients (48 male, 221 female) were surveyed at baseline, and 44 providers and 300 clients (70 male, 230 female) at endline. Various factors including relationship status, parity and ART access influenced PLHIVs’ desires for children. Concerns for their own and their child’s health impacted on PLHIV’s fertility desires. These concerns declined after integration of services. Similarly, providers’ concerns about PLHIV having children decreased after the implementation of the model. Conclusions Integrated services are important to facilitate provision of information on contraceptive options as well as safer conception information for PLHIV who want to have children.

scholarly journals The Comorbidity of HIV, Hypertension and Diabetes: A Qualitative Study Exploring the Challenges Faced by Healthcare Providers and Patients in Selected Urban and Rural Health Facilities where the ICDM Model is Implemented in South Africa

2020 ◽  
Author(s):  
Motlatso Godongwana ◽  
Nicole De Wet Billings ◽  
Minja Milovanovic
Keyword(s):  
South Africa ◽  
Financial Burden ◽  
Healthcare Providers ◽  
Health Facilities ◽  
People Living With Hiv ◽  
Access To Treatment ◽  
Increased Risk ◽  
Economic Barriers ◽  
Living With Hiv ◽  
Chronic Comorbidities

Abstract BackgroundPeople living with HIV (PLWH) are living longer as a result of advancement and adherence to antiretroviral therapy. As the life expectancy of PLWH increases, they are at increased risk of hypertension. MethodsWe conducted 24 in-depth interviews to understand the challenges faced by healthcare providers and PLWH with chronic comorbidities under the Integrated Chronic Disease Management (ICDM) model implemented in health facilities in South Africa. Thematic content analysis was conducted. ResultsThe challenges experienced included lack of staff capacity, unclear guidelines on the delivery of integrated care for patients with HIV chronic comorbidities, pill burden, non-disclosure, financial burden, poor knowledge of treatments, relocation of patients and access to treatment. Lack of support and integrated chronic programmes including minimal information regarding the management of HIV chronic comorbidities were another concern. ConclusionStandardised guidelines and training, increasing staff capacity and addressing socio-economic barriers is critical to achieving the outcomes of the ICDM.

scholarly journals Trajectories of fertility intentions among women living with HIV in South Africa

AIDS Care ◽  
2020 ◽  
pp. 1-7
Author(s):  
Katherine B. Rucinski ◽  
Kimberly A. Powers ◽  
Audrey E. Pettifor ◽  
Vivian Black ◽  
Brian W. Pence ◽  
...  
Keyword(s):  
South Africa ◽  
Fertility Intentions ◽  
Women Living With Hiv ◽  
Living With Hiv

scholarly journals Relationship, partner factors and stigma are associated with safer conception information, motivation, and behavioral skills among women living with HIV in Botswana

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah A. Gutin ◽  
Gary W. Harper ◽  
Neo Moshashane ◽  
Kehumile Ramontshonyana ◽  
Rob Stephenson ◽  
...  
Keyword(s):  
Significant Proportion ◽  
Reproductive Age ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Specific Information ◽  
Safer Conception ◽  
Behavioral Skills ◽  
Medical Male Circumcision ◽  
Women Living With Hiv ◽  
Living With Hiv

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.

scholarly journals Fertility desires of people living with HIV: does the implementation of a sexual and reproductive health and HIV integration model change healthcare providers’ attitudes and clients’ desires?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Cecilia Milford ◽  
Mags Beksinska ◽  
Ross Greener ◽  
Jacqueline Pienaar ◽  
Letitia Rambally Greener ◽  
...  
Keyword(s):  
Reproductive Health ◽  
Sexual And Reproductive Health ◽  
Healthcare Providers ◽  
People Living With Hiv ◽  
Safer Conception ◽  
Cross Sectional Survey ◽  
Integration Model ◽  
Fertility Desires ◽  
Integration Of Services ◽  
Living With Hiv

Abstract Background There is a need for information and healthcare support for the fertility desires and contraceptive needs of people living with HIV (PLHIV) in order to provide safer conception support for sero-discordant couples wanting to safely conceive. A model to integrate sexual and reproductive health and HIV services was developed and implemented in a district hospital and six clinics in the eThekwini District, South Africa. Methods To evaluate the model’s success, a cross-sectional survey was conducted before and after implementation of the model. As part of this evaluation, fertility desires of PLHIV (both male and female), and providers’ perspectives thereof were explored. Changes in desires and attitudes after integration of services were investigated. Results Forty-six healthcare providers and 269 clients (48 male, 221 female) were surveyed at baseline, and 44 providers and 300 clients (70 male, 230 female) at endline. Various factors including relationship status, parity and antiretroviral treatment (ART) access influenced PLHIVs’ desires for children. Concerns for their own and their child’s health negatively impacted on PLHIV’s fertility desires. These concerns declined after integration of services. Similarly, providers’ concerns about PLHIV having children decreased after the implementation of the model. Conclusions Integrated services are important to facilitate provision of information on contraceptive options as well as safer conception information for PLHIV who want to have children.

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