People living with HIV (PLHIV) continue to have children after being diagnosed with HIV, yet little research attention has been paid to actual lived childbearing experiences of PLHIV post-HIV diagnosis.
We interviewed 10 HIV-positive women and 11 HIV-positive men in Iringa, Tanzania, about their experiences of conceiving and having children after being diagnosed with HIV. We adopted an approach to data analysis based on grounded theory and phenomenology. Participants' experiences were shaped by social and institutional factors.
- Some participants reported pressures to bear children by partners and relatives,
- Whereas others reported negative reactions from others concerning their pregnancies.
- Most participants had not discussed having children with a provider before attempting to conceive.
- Some reported being reprimanded by health providers for getting pregnant without seeking their advice.
Consideration of support systems and challenges surrounding the childbearing experiences of PLHIV can help inform reproductive health interventions for those who desire children.
- 1Johns Hopkins University, Baltimore, Maryland, USA hsaleem@jhu.edu.
- 2Johns Hopkins University, Baltimore, Maryland, USA.
Safer conception interventions can significantly reduce the risk of horizontal HIV transmission between HIV-serodiscordant partners. However, prior to implementing safer conception interventions, it is essential to understand potential barriers to their adoption so that strategies can be developed to overcome these barriers. This paper examines potential barriers to the adoption of safer conception strategies by HIV-affected couples in Iringa, Tanzania using an ecological framework.
We interviewed 30 HIV-positive women, 30 HIV-positive men and 30 health providers engaged in delivering HIV-related services. We also conducted direct observations at five health facilities. Findings suggest that there are multiple barriers to safer conception that operate at the individual, relational, environmental, structural, and super-structural levels. The barriers to safer conception identified are complex and interact across these levels. Barriers at the individual level included:
- antiretroviral adherence,
- knowledge of HIV status,
- knowledge and acceptability of safer conception strategies,
- and poor nutrition.
At the relational level, unplanned pregnancies, non-disclosure of status, gendered power dynamics within relationships, and patient-provider interactions posed a threat to safer conception. HIV stigma and distance to health facilities were environmental barriers to safer conception. At the structural level there were multiple barriers to safer conception, including limited safer conception policy guidelines for people living with HIV (PLHIV), lack of health provider training in safer conception strategies and preconception counseling for PLHIV, limited resources, and lack of integration of HIV and sexual and reproductive health services. Poverty and gender norms were super-structural factors that influenced and reinforced barriers to safer conception, which influenced and operated across different levels of the framework.
Multi-level interventions are needed to ensure adoption of safer conception strategies and reduce the risk of HIV transmission between partners within HIV-serodiscordant couples.
Via: http://ht.ly/S9YsI
By: Saleem HT1, Surkan PJ, Kerrigan D, Kennedy CE.
- 1a Department of International Health , Bloomberg School of Public Health, Johns Hopkins University , 615 N. Wolfe Street, Baltimore , MD 21205 , USA.
