Saturday, February 27, 2016

Sexuality and Reproduction in HIV-Positive Women: A Meta-Synthesis

The increased access to effective antiretroviral treatment (ART) has made HIV comparable to a chronic disease in terms of life expectancy. Needs related to sexuality and reproduction are central to overall health and well-being. An interpretative meta-synthesis was performed to synthesize and assess how HIV-positive women's experiences of sexuality and reproduction have been described in qualitative studies. A total of 18 peer-reviewed qualitative studies were included, which comprised a total of 588 HIV-positive interviewed women. The studies originated from resource-rich countries outside the Asian and African continents. The analysis, resulting in a lines-of-argument synthesis, shows that HIV infection was a burden in relation to sexuality and reproduction. The weight of the burden could be heavier or lighter. Conditions making the HIV burden heavier were: HIV as a barrier, feelings of fear and loss, whereas motherhood, spiritual beliefs, and supportive relationships made the HIV burden lighter. The findings are important in developing optimal health care by addressing conditions making the burden of HIV infection lighter to bear. In future research there is a need to focus not only on examining how HIV-positive women's sexual and relationships manifest themselves, but also on how health care professionals should provide adequate support to the women in relation to sexuality and reproduction.

...Ah, it's just always in the bedroom, HIV. It's always there, p.7

...In holistic care, it is important for health care professionals to see the women as whole individuals and not only focus on the disease. The result emphasizes the strength of support from health care professionals. But support is not only offering information; support is also about listening. There were narratives in the included studies of experiences of violence, which the women might need help to handle. As health care professionals, we have to ask and be open to stories of, for example, rape, or abuse. Supporting self-acceptance and awareness are only a few of the many areas where care providers outside the medical context can be important for patients' ongoing well-being. The importance of support from other HIV-positive women is emphasized in the meta-synthesis.,,,, Even though it is difficult for some women to attend support meetings like this, as it means they have to disclose their HIV-positive status, it is important to motivate women to meet other HIV-positive persons.

...There is a need for practical information about contraceptives, medical risks, and interventions related to the risk of HIV transmission and barriers between fertility intentions, and pregnancy seeking behavior also need to be illuminated. Women actively trying to conceive intend not to talk with their provider about safer conception strategies and they expressed confusion and concern on how to conceive safely. Reproductive counseling initiated by health care providers is needed to reduce risk of transmission to partners and infants, which can have major health implications.

Disclosure of HIV-positive status seems problematic, and some women may need the presence of a health care professional when the disclosure is made. Everything has to be done without judgment; it is important for health care professionals not to relate to their personal sexual behaviors as the sexual norm.

In clinical practice, it might be of importance to address all these conditions that make the burden easier, to support pregnancy, to support the desires of these women, and to help them cope with negative feelings, in order to promote the sexual and reproductive health of HIV-positive women.

Full article at:

By:  Ewa Carlsson-Lalloo, RN, MHCSci,*1,,2 Marie Rusner, RN, MSc, PhD,1,,3 Åsa Mellgren, MD, PhD,2,,3 and Marie Berg, RN, RM, MNSci, MPH, PhD1,,4
1Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg, Sweden.
2Clinic of Infectious Diseases, Södra Älvsborg Hospital, Borås, Sweden.
3Department of Research, Södra Älvsborg Hospital, Borås, Sweden.
4Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
*Corresponding author.
Address correspondence to:, Ms. Ewa Carlsson-Lalloo, Institute of Health and Care Sciences, Box 457, University of Gothenburg, 405 30 Gothenburg, Sweden,

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