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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: 25] [Impact Index Per Article: 6.3] [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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Chirambira P, Madiba S, Ntuli B. Societal and individual drivers of fertility desires and intentions among people living with HIV: a cross sectional study of HIV clinic attendees in Soweto, South Africa. AIMS Public Health 2021; 9:173-184. [PMID: 35071676 PMCID: PMC8755963 DOI: 10.3934/publichealth.2022013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
Background High proportion of people living with HIV (PLHIV) who are in the prime of their reproductive years desire to have children. There are limited studies that explore the range of fertility intentions for PLHIV. This study investigated the fertility desires and intentions of PLHIV and the associated factors. Methods This was a cross-sectional study of 442 PLHIV receiving antiretroviral treatment (ART) in health facilities in Soweto, an urban township that is situated in the City of Johannesburg in South Africa. STATA version 13 was used to analyze the data. Results The participants' mean age was 36.3 years, 70% were females, 79.6% had at least one biological child, and 36% had 3+ children. Almost half (47%) expressed the desire for children, saying that this was because they had no biological children, or their partners wanted children, or they wanted children of a particular sex, or were feeling healthy after taking ART. An increased fertility desire was associated with absence of biological children (AOR = 5.06, 95% CI: 2.11–12.1) and with being married (AOR = 2.63, 95% CI: 1.31–5.27). A decreased fertility desire was associated with being aged 36+ (AOR = 2.63, 95% CI: 1.31–5.27), having primary education (AOR = 0.11, 95% CI: 0.01–1.30) and having ≥4 years of ART duration (AOR = 0.45, 95% CI: 0.24–0.81). Conclusion Individual factors played a significant role in shaping the fertility desires of PLHIV in this setting. The high desire for children underscore the need to integrate reproductive health services in HIV and AIDS care and treatment services and develop safer conception programmes to help PLHIV to conceive and have children safely.
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Mosisa G, Tsegaye R, Wakuma B, Mulisa D, Etefa W, Abadiga M, Fekadu G, Oluma A, Turi E. Fertility desire and associated factors among people living with HIV in Ethiopia: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2020; 78:123. [PMID: 33292626 PMCID: PMC7685622 DOI: 10.1186/s13690-020-00504-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/05/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Increased Anti-Retroviral Therapy (ART) coverage improves health status and the survival of people living with Human Immunodeficiency Virus (HIV) as a result, reproductive health needs of the clients are increased. As part of continuum HIV care, understanding fertility desire and reproductive health care needs of HIV positive peoples will play paramount role in planning and delivering appropriate health services. The finding of studies conducted on the fertility desire and associated factors among People Living with HIV in Ethiopia presented inconclusive. Therefore, this study aimed to assess the pooled prevalence of fertility desire and associated factors among people living with HIV in Ethiopia. METHODS A total of 26 studies conducted in Ethiopia were included in this Meta-analysis. Pub Med, HINARI, Google scholar and Google data bases were searched. Data from the included articles were extracted using a standardized data extraction tool. The included studies were analyzed using a random effects meta-analysis model. Analysis was done Using STATA version 14 statistical software. Heterogeneity was assessed statistically using the standard Chi-square, I2. The association between fertility desire and factors were examined using a random effects model. RESULT In this meta-analysis, the pooled prevalence of fertility desire in Ethiopia is 42.21% (95%CI 39.18, 45.25). Fertility desire is significantly associated with sex: being female (OR = 0.71,95%CI 0.57,0.86), partners desire (OR = 16.8, 95% CI: 9.45, 29.88), not having child (OR = 5.46 95%CI 4.24, 7.040), age < 30(OR = 2.34, 95%CI 2.10, 2.60), formal education (OR = 1.31 95%CI 1.09, 1.59)). However, use of family planning, residence, and Knowledge on Prevention of Mother to Child Transmission and disclosure status didn't show association with fertility desire. CONCLUSION In this finding, significant people of living with HIV have a desire to have a child. The finding showed the need to strengthen fertility desire and reproductive health care needs of HIV positive peoples. Therefore, strengthening the integration of fertility related issues with HIV continuum care will play a paramount role in averting risky sexual behaviors and Prevention of Mother to Child Transmission among peoples on ART.
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Affiliation(s)
- Getu Mosisa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Reta Tsegaye
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Bizuneh Wakuma
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Diriba Mulisa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Werku Etefa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Muktar Abadiga
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Ginenus Fekadu
- Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Adugna Oluma
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Ebisa Turi
- Department of Public health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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Schwartz SR, Bassett J, Mutunga L, Yende N, Mudavanhu M, Phofa R, Sanne I, Van Rie A. HIV incidence, pregnancy, and implementation outcomes from the Sakh'umndeni safer conception project in South Africa: a prospective cohort study. Lancet HIV 2019; 6:e438-e446. [PMID: 31160268 DOI: 10.1016/s2352-3018(19)30144-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 03/22/2019] [Accepted: 03/28/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Safer conception strategies empower individuals trying to conceive to minimise HIV transmission risk to partners and potential children; however, effectiveness data are scarce. We aimed to assess adoption of safer conception methods and HIV and pregnancy outcomes from Sakh'umndeni, a novel safer conception service in South Africa. METHODS In this prospective cohort study, the Sakh'umndeni clinical cohort at Witkoppen Cinic in Johannesburg (South Africa) enrolled adults aged at least 18 years who were trying to conceive and in relationships with an HIV-positive partner. Couples who were pregnant at enrolment or had been previously diagnosed as infertile were excluded. Participants received safer conception care by a nurse, including antiretroviral therapy (ART) for HIV-positive partners, pre-exposure prophylaxis (PrEP) for HIV-negative partners, counselling around timed condomless sex, or syringes for self-insemination. Primary outcomes were pregnancy incidence and HIV transmission to partners and infants. We estimated time to first pregnancy using Kaplan-Meier curves; pregnancy and HIV incidence were estimated as events per person-years of risk. FINDINGS Between July 16, 2013, and April 5, 2017, 526 individuals (334 women and 192 men) from 334 partnerships enrolled. 162 (48%) of 334 couples were serodifferent, 149 (45%) were HIV-positive seroconcordant, and 23 (7%) were an HIV-positive woman and an unknown status male partner. At enrolment, 176 (61%) of 287 HIV-positive women and 60 (46%) of 131 HIV-positive men were virally suppressed (<50 copies per mL). Among the safer conception strategies, ART was initiated by 73 (91%) of 80 HIV-positive participants not on ART and PrEP was initiated by 28 (28%) of 101 HIV-negative participants. 2719 follow-up visits were completed, and 99 pregnancies were observed in 89 women. Pregnancy incidence was 41·2 per 100 person-years (95% CI 33·4-50·7); 25 (28%) of 89 pregnancies with a known outcome were miscarried or terminated because of risk to the mother. Pregnancy incidence was 79·0 per 100 person-years (95% CI 49·8-125·4) among HIV-negative women and 36·7 per 100 person-years (29·1-46·3) among HIV-positive women. At the time of pregnancy, viral suppression among women was high (68 [87%] of 78 women had viral loads of <50 copies per mL and 77 [99%] had viral loads of <1000 copies per mL). No horizontal or vertical HIV transmission events were observed. INTERPRETATION Safer conception strategies empowered couples to safely conceive. Pregnancy incidence among service users was high. Integration of safer conception counselling could promote HIV prevention and linkage to care. FUNDING US Agency for International Development; UJMT Consortium/Fogarty International Center, US National Institutes of Health (NIH); and Johns Hopkins University Center for AIDS Research (NIH).
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Affiliation(s)
- Sheree R Schwartz
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
| | - Jean Bassett
- Witkoppen Health and Welfare Centre, Johannesburg, South Africa
| | - Lillian Mutunga
- Witkoppen Health and Welfare Centre, Johannesburg, South Africa
| | - Nompumelelo Yende
- Witkoppen Health and Welfare Centre, Johannesburg, South Africa; Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Mutsa Mudavanhu
- Witkoppen Health and Welfare Centre, Johannesburg, South Africa
| | - Rebecca Phofa
- Witkoppen Health and Welfare Centre, Johannesburg, South Africa; Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ian Sanne
- Clinical HIV Research Unit, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa; Right to Care, Johannesburg, South Africa
| | - Annelies Van Rie
- Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
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Schwartz S, Davies N, Naidoo N, Pillay D, Makhoba N, Mullick S. Clients' experiences utilizing a safer conception service for HIV affected individuals: implications for differentiated care service delivery models. Reprod Health 2019; 16:65. [PMID: 31138252 PMCID: PMC6538560 DOI: 10.1186/s12978-019-0718-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Safer conception services promote the reproductive health and rights of families, while minimizing HIV transmission risks between partners trying to conceive, as well vertical transmission risks. Implementation data, including clients’ experiences utilizing safer conception services in sub-Saharan Africa are limited. Methods Hillbrow Community Health Centre began offering safer conception services for individuals and couples affected by HIV in Johannesburg, South Africa in June 2015. A stratified sub-sample of safer conception clients were consecutively recruited from April 2016–August 2017 for a cross-sectional interview assessing clients’ perceptions of service acceptability and value, as well as perceived safer conception knowledge and self-efficacy. Visual analog scales from 0 to 100 were used to measure clients’ experiences; scores were classified as low, moderate and high acceptance/value/knowledge/self-efficacy if they were < 50, 50–79 and ≥ 80 respectively. Comparisons of scores were made across safer conception visits attended. Results Among 692 clients utilizing safer conception services, 120 (17%) were sampled for the process evaluation; sub-sample participant characteristics were similar to the overall cohort. Clients gave a mean score of ≥90-points for each question assessing service acceptability and 96% (114/119) indicated a high perceived value (scores ≥80) for regular safer conception attendance until conception. Fifty-eight percent (n = 70) of clients reported learning something new during the visit completed the day of the survey, though acquisition of new information tended to decrease as visits increased (p = 0.09). In terms of safer conception strategies, 80% of clients reported high levels of knowledge on the impact of antiretroviral treatment (ART) and viral suppression on HIV transmission, 67% reported high levels of knowledge of the importance of STI screening and 56% regarding limiting condomless sex to days of peak fertility; 34% in sero-different relationships reported high pre-exposure prophylaxis (PrEP) knowledge. Self-efficacy varied by safer conception methods and was similar across study visits. Conclusions Clients perceived high value from their safer conception visits and preferred regular attendance until conception, however we observed a plateau in knowledge and self-efficacy across subsequent visits after initially attending safer conception care. More intensive services may be appropriate for certain clients based on clinical circumstances, but many couples may potentially receive a ‘lighter touch’ approach while still minimizing HIV transmission risks. Electronic supplementary material The online version of this article (10.1186/s12978-019-0718-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sheree Schwartz
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA. .,Wits Reproductive Health Institute, University of the Witwatersrand, Johannesburg, South Africa.
| | - Natasha Davies
- Wits Reproductive Health Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicolette Naidoo
- Wits Reproductive Health Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Diantha Pillay
- Wits Reproductive Health Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Nokuthula Makhoba
- Wits Reproductive Health Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Saiqa Mullick
- Wits Reproductive Health Institute, University of the Witwatersrand, Johannesburg, South Africa
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Mayhew SH, Colombini M, Kimani JK, Tomlin K, Warren CE, Mutemwa R. Fertility intentions and contraceptive practices among clinic-users living with HIV in Kenya: a mixed methods study. BMC Public Health 2017; 17:626. [PMID: 28679389 PMCID: PMC5498886 DOI: 10.1186/s12889-017-4514-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preventing unwanted pregnancies in Women Living with HIV (WLHIV) is a recognised HIV-prevention strategy. This study explores the fertility intentions and contraceptive practices of WLHIV using services in Kenya. METHODS Two hundred forty women self-identifying as WLHIV who attended reproductive health services in Kenya were interviewed with a structured questionnaire in 2011; 48 were also interviewed in-depth. STATA SE/13.1, Nvivo 8 and thematic analysis were used. RESULTS Seventy one percent participants did not want another child; this was associated with having at least two living children and being the bread-winner. FP use was high (92%) but so were unintended pregnancies (40%) while living with HIV. 56 women reported becoming pregnant "while using FP": all were using condoms or short-term methods. Only 16% participants used effective long-acting reversible contraceptives or permanent methods (LARC-PM). Being older than 25 years and separated, widowed or divorced were significant predictors of long-term method use. Qualitative data revealed strong motivation among WLHIV to plan or prevent pregnancies to avoid negative health consequences. Few participants received good information about contraceptive choices. CONCLUSIONS WLHIV need better access to FP advice and a wider range of contraceptives including LARC to enable informed choices that will protect their fertility intentions, ensure planned pregnancies and promote safe child-bearing. TRIAL REGISTRATION Integra is a non-randomised pre-post intervention trial registered with Current Controlled Trials ID: NCT01694862 .
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Affiliation(s)
- Susannah H Mayhew
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK.
| | - Manuela Colombini
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - James Kelly Kimani
- Department for International Development (DfID), (at the time of this research, Kimani was with the Population Council, Nairobi), Nairobi, Kenya
| | - Keith Tomlin
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | | | | | - Richard Mutemwa
- Centre for Infectious Disease Research (at the time of this research, Mutemwa was with the LSHTM), Lusaka, Zambia
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Agbo S, Rispel LC. Factors influencing reproductive choices of HIV positive individuals attending primary health care facilities in a South African health district. BMC Public Health 2017; 17:540. [PMID: 28576142 PMCID: PMC5457556 DOI: 10.1186/s12889-017-4432-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 05/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is global recognition of the reproductive health rights of people living with HIV (PLHIV). The aim of this research study was to explore the reproductive choices, and the factors influencing these choices, of HIV positive patients attending primary health care (PHC) facilities in the Ekurhuleni health district of the Gauteng Province of South Africa. METHODS During 2013, a cross-sectional survey was conducted in the Ekurhuleni health district. At each of three randomly selected community health centres, a random sample of HIV positive patients was selected. After informed consent was obtained, trained fieldworkers administered a structured questionnaire that elicited information on socio-demographics, reproductive choices and knowledge of reproductive options. Survey data were analysed using STATA® 13. RESULTS The majority of survey participants (n = 430) were female (70%) and unemployed (57%). The mean age of participants was 36.4 years (SD 8.6): 40.8 years (SD 8.7) for men and 34.5 years (SD7.8) for women. Among survey participants, 46% expressed a desire for children (95% CI: 41.4-50.9). In the multiple logistic regression analysis, predictors of desire for children were age less than 49 years, marriage or living together, and no biological children. The odds of wanting children was 16.48 [95% CI: 5.94-45.74] times higher for PLHIV without children, compared with those with two or more children, while for those less than 25 years, the odds of wanting children was 0.78 [95% CI: 0.23-2.59] compared with those older than 50 years. The PLHIV knowledge on the available reproductive options was limited, with the majority relying on the guidance of the health workers. CONCLUSION Health care providers at PHC level should be educated to address the reproductive health needs of PLHIV. These aspects should be reflected in provincial and national health policies.
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Affiliation(s)
- Samuel Agbo
- Department of Family Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- P.O BOX 12089, Tramshed, Pretoria, 0126 South Africa
| | - Laetitia C. Rispel
- Centre for Health Policy & DST/NRF Research Chair, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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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: 1.8] [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: 1.4] [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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Antelman G, Medley A, Mbatia R, Pals S, Arthur G, Haberlen S, Ackers M, Elul B, Parent J, Rwebembera A, Wanjiku L, Muraguri N, Gweshe J, Mudhune S, Bachanas P. Pregnancy desire and dual method contraceptive use among people living with HIV attending clinical care in Kenya, Namibia and Tanzania. ACTA ACUST UNITED AC 2016; 41:e1. [PMID: 25512359 DOI: 10.1136/jfprhc-2013-100784] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM To describe factors associated with pregnancy desire and dual method use among people living with HIV in clinical care in sub-Saharan Africa. DESIGN Sexually active HIV-positive adults were enrolled in 18 HIV clinics in Kenya, Namibia and Tanzania. Demographic, clinical and reproductive health data were captured by interview and medical record abstraction. Correlates of desiring a pregnancy within the next 6 months, and dual method use [defined as consistent condom use together with a highly effective method of contraception (hormonal, intrauterine device (IUD), permanent)], among those not desiring pregnancy, were identified using logistic regression. RESULTS Among 3375 participants (median age 37 years, 42% male, 64% on antiretroviral treatment), 565 (17%) desired a pregnancy within the next 6 months. Of those with no short-term fertility desire (n=2542), 686 (27%) reported dual method use, 250 (10%) highly effective contraceptive use only, 1332 (52%) condom use only, and 274 (11%) no protection. Respondents were more likely to desire a pregnancy if they were from Namibia and Tanzania, male, had a primary education, were married/cohabitating, and had fewer children. Factors associated with increased likelihood of dual method use included being female, being comfortable asking a partner to use a condom, and communication with a health care provider about family planning. Participants who perceived that their partner wanted a pregnancy were less likely to report dual method use. CONCLUSIONS There was low dual method use and low use of highly effective contraception. Contraceptive protection was predominantly through condom-only use. These findings demonstrate the importance of integrating reproductive health services into routine HIV care.
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Affiliation(s)
- Gretchen Antelman
- Research and Evaluation Director (Tanzania), ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Amy Medley
- Behavioral Scientist, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Redempta Mbatia
- Executive Director, Tanzania Health Promotion Support, Dar es Salaam, United Republic of Tanzania
| | - Sherri Pals
- Mathematical Statistician, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gilly Arthur
- Associate Director of Science, CTS Global Inc., assigned to US Centers for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania
| | - Sabina Haberlen
- Science Office Team Lead, CTS Global Inc., assigned to US Centers for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania
| | - Marta Ackers
- HIV Care and Treatment Branch Chief, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Batya Elul
- Director of Strategic Information (ICAP) and Assistant Professor of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Julie Parent
- Study Coordinator, Ministry of Health and Social Services, Windhoek, Namibia
| | - Anath Rwebembera
- Pediatrician, Ministry of Health and Social Welfare, Dar es Salaam, United Republic of Tanzania
| | - Lucy Wanjiku
- Senior Care and Treatment Medical Officer, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | | | - Justice Gweshe
- Chief Medical Officer and National Programme Manager, Ministry of Health and Social Services, Windhoek, Namibia
| | - Sandra Mudhune
- Senior M&E Officer, Research and Evaluation, The International Center for AIDS Care and Treatment Programs (ICAP), Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Pamela Bachanas
- Behavioral Scientist, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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11
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Ddumba-Nyanzi I, Kaawa-Mafigiri D, Johannessen H. Barriers to communication between HIV care providers (HCPs) and women living with HIV about child bearing: A qualitative study. PATIENT EDUCATION AND COUNSELING 2016; 99:754-759. [PMID: 26680756 DOI: 10.1016/j.pec.2015.11.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 10/30/2015] [Accepted: 11/22/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES In the context of HIV clinical care, open discussion regarding sexual health and reproductive plans has become increasingly relevant. The aim of this paper is to explore barriers to communication between providers and women living with HIV regarding childbearing. METHODS In-depth interviews (IDIs) were conducted with 48 HIV infected women receiving ART at 7 different HIV clinics providing comprehensive HIV care services in four districts in Uganda, between July and August 2012. All women were aware of their HIV diagnosis prior to pregnancy or had given birth while living with HIV. RESULTS Four themes emerged describing barriers to communication, from the HIV-positive women's point of view: (i) provider indifference or opposition to childbearing post HIV diagnosis, (ii) anticipation of negative response from provider, (iii) provider's emphasis on 'scientific' facts, (iv) 'accidental pregnancy'. CONCLUSION Existing evidence regarding effective provider-patient communication should be considered for its application for reproductive counseling among HIV infected women. PRACTICE IMPLICATIONS These data demonstrate the need for current counseling guidelines to explore approaches that encourage open, non-judgmental, non-directive discussions with HIV positive individuals around their reproductive desires and intentions in a health care setting.
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Affiliation(s)
- Ismael Ddumba-Nyanzi
- Department of Social Work and Social Administration, Makerere University Kampala, Uganda.
| | - David Kaawa-Mafigiri
- Department of Social Work and Social Administration, Makerere University Kampala, Uganda.
| | - Helle Johannessen
- Department of Public Health, University of Southern Denmark, Denmark.
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12
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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). SEXUAL & REPRODUCTIVE HEALTHCARE 2016; 10:35-40. [PMID: 27938871 DOI: 10.1016/j.srhc.2016.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [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.
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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
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13
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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: 0.6] [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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14
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Advancing the sexual and reproductive health and human rights of women living with HIV: a review of UN, regional and national human rights norms and standards. J Int AIDS Soc 2015; 18:20280. [PMID: 26643455 PMCID: PMC4672403 DOI: 10.7448/ias.18.6.20280] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 10/05/2015] [Accepted: 10/14/2015] [Indexed: 11/29/2022] Open
Abstract
Introduction The right to sexual and reproductive health (SRH) is an essential part of the right to health and is dependent upon substantive equality, including freedom from multiple and intersecting forms of discrimination that result in exclusion in both law and practice. Nonetheless, general and specific SRH needs of women living with HIV are often not adequately addressed. For example, services that women living with HIV need may not be available or may have multiple barriers, in particular stigma and discrimination. This study was conducted to review United Nations Human Rights Council, Treaty Monitoring Bodies and Special Rapporteur reports and regional and national mechanisms regarding SRH issues of women living with HIV. The objective is to assess areas of progress, as well as gaps, in relation to health and human rights considerations in the work of these normative bodies on health and human rights. Methods The review was done using keywords of international, regional and national jurisprudence on findings covering the 2000 to 2014 period for documents in English; searches for the Inter-American Commission on Human Rights and national judgments were also conducted in Spanish. Jurisprudence of UN Treaty Monitoring Bodies, regional mechanisms and national bodies was considered in this regard. Results and discussion In total, 236 findings were identified using the search strategy, and of these 129 were selected for review based on the inclusion criteria. The results highlight that while jurisprudence from international, regional and national bodies reflects consideration of some health and human rights issues related to women living with HIV and SRH, the approach of these bodies has been largely ad hoc and lacks a systematic integration of human rights concerns of women living with HIV in relation to SRH. Most findings relate to non-discrimination, accessibility, informed decision-making and accountability. There are critical gaps on normative standards regarding the human rights of women living with HIV in relation to SRH. Conclusions A systematic approach to health and human rights considerations related to women living with HIV and SRH by international, regional and national bodies is needed to advance the agenda and ensure that policies and programmes related to SRH systematically take into account the health and human rights of women living with HIV.
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15
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Pintye J, Ngure K, Curran K, Vusha S, Mugo N, Celum C, Baeten JM, Heffron R. Fertility Decision-Making Among Kenyan HIV-Serodiscordant Couples Who Recently Conceived: Implications for Safer Conception Planning. AIDS Patient Care STDS 2015; 29:510-6. [PMID: 26301703 DOI: 10.1089/apc.2015.0063] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
HIV-serodiscordant couples often choose to attempt pregnancy despite their HIV transmission risk. Optimizing delivery of HIV risk reduction strategies during peri-conception periods (i.e., safer conception) requires understanding how HIV-serodiscordant couples approach fertility decisions. We conducted 36 in-depth individual interviews with male and female partners of Kenyan heterosexual HIV-serodiscordant couples who recently conceived. Transcripts were analyzed by gender and HIV serostatus using open coding. Matrices were used to identify patterns and emerging themes. Most participants expressed acceptance of being in an HIV-serodiscordant couple and affirmed their resilience to live with serodiscordance and achieve their fertility goals. Overall, while the goal for childbearing was unchanged, conception became an urgent desire so that both partners could experience childrearing together while the HIV-infected partner was still healthy. Children also add value to the relationship, and multiple children were a commonly expressed desire. Couples' desires dominated those of individual partners in fertility decision-making, but male preferences were more influential when the individual desires differed. Values and preferences of the couple as a unit may mediate fertility decision-making in HIV-discordant couples. Thus, it is important that safer conception programs include both partners when appropriate and consider the relationship context during risk reduction counseling and when recommending risk reduction interventions.
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Affiliation(s)
- Jillian Pintye
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Nursing, University of Washington, Seattle, Washington
| | - Kenneth Ngure
- Department of Global Health, University of Washington, Seattle, Washington
- College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | - Kathryn Curran
- Department of Global Health, University of Washington, Seattle, Washington
| | - Sophie Vusha
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Nelly Mugo
- Department of Global Health, University of Washington, Seattle, Washington
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Jared M. Baeten
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
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16
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van Zyl C, Visser MJ. Reproductive desires of men and women living with HIV: implications for family planning counselling. Reprod Biomed Online 2015. [PMID: 26208447 DOI: 10.1016/j.rbmo.2015.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The reproductive desires of people living with HIV/AIDS (PLHIV) of low socioeconomic standing attending public health facilities in South Africa were studied. HIV-positive men, pregnant and non-pregnant women were recruited from two clinics at a large public hospital in Tshwane, South Africa. Individual interviews were used to explore the reproductive desires of HIV-positive participants. HIV counsellors' perceptions of their clients' reproductive desires were explored during focus group discussions. Parenthood proved to be an important factor to all participants in continuation of the family and establishing their gender identities, despite the possible risk of HIV transmission and community stigmatization. Different cultural procreation rules for men and women and stigmatizing attitudes towards PLHIV affected their reproductive decision making. Women had the dilemma of choosing which community expectations they wanted to fulfil. Community stigmatization towards PLHIV was visible in the negative attitudes of some HIV counsellors regarding HIV and procreation. Because the reproductive desires of PLHIV are currently not given high priority in HIV prevention and family planning in the public health sector in South Africa, the prevention of HIV transmission may be jeopardized. These results necessitate the integration of HIV and sexual and reproductive health counselling on a primary health care level.
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Affiliation(s)
- Cornelia van Zyl
- Wilgers Infertility Clinic, Wilgers Hospital, Pretoria, South Africa
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17
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Community perceptions of childbearing and use of safer conception strategies among HIV-discordant couples in Kisumu, Kenya. J Int AIDS Soc 2015; 18:19972. [PMID: 26077644 PMCID: PMC4468054 DOI: 10.7448/ias.18.1.19972] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 04/19/2015] [Accepted: 05/06/2015] [Indexed: 11/08/2022] Open
Abstract
Introduction Safer conception strategies (SCS) have the potential to decrease HIV transmission among HIV-discordant couples who desire children. Community perceptions of SCS may influence the scale-up and uptake of these services, but little is known about how communities will react to these strategies. Without community support for SCS, their success as an HIV prevention tool may be limited. The objective of this study is to characterize community perceptions of SCS for HIV-discordant couples in Kisumu, Kenya, to inform ongoing and future safer conception intervention studies in low-resource settings. Methods We conducted six focus group discussions and 11 in-depth-interviews in Kisumu, Kenya, among a diverse group (N=59) of community members, including men, women, youth (age 19–25), community health workers and local leaders. An iterative qualitative analysis using a grounded theory approach was employed. Results and discussion All participants emphasized the importance of childbearing in their society and the right to have children, regardless of an individual's HIV status. While most participants believed that HIV-discordant couples should be allowed to have children, they discussed several barriers to the uptake of SCS such as HIV-related stigma, fear of HIV transmission to the uninfected partner and child, fear of unfamiliar medical procedures and lack of information among community members and health care providers about HIV prevention interventions that allow safer conception. Access to information, community experiences with successful safer conception interventions, healthcare provider training, male engagement and community mobilization may help overcome these barriers. Though assisted reproduction strategies generated the most negative reactions from participants, our results suggest that with education and explanation of these services, participants express interest in these strategies and want them to be offered in their community. Conclusions Many community members noted a need and desire for safer conception education and services in Kisumu. However, community barriers such as fear, stigma and lack of information should be addressed before safer conception interventions can be successfully implemented and delivered. Further research focused on community education, male engagement and healthcare provider training is a crucial next step in delivering safer conception in this region.
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18
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Nedjat S, Moazen B, Rezaei F, Hajizadeh S, Majdzadeh R, Setayesh HR, Mohraz M, Gooya MM. Sexual and reproductive health needs of HIV-positive people in Tehran, Iran: a mixed-method descriptive study. Int J Health Policy Manag 2015; 4:591-8. [PMID: 26340488 DOI: 10.15171/ijhpm.2015.68] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 03/14/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND People Living with HIV (PLHIV) are highly stigmatized and consequently hard-to-access by researchers and importantly, public health outreach in Iran, possibly due to the existing socio-cultural situation in this country. The present study aimed to evaluate the sexual and reproductive health needs of PLHIV in Tehran, the capital of Iran. METHODS As a mixed-method descriptive study, this project was conducted in 2012 in Tehran, Iran. In this study, we evaluated and discussed socio-demographic characteristics, family and social support, sexual behaviors, fertility desires and needs, PMTCT services, contraceptive methods, unintended pregnancy and safe abortion, and Pap smear tests among 400 participants referring to the behavioral disorders consulting centers. RESULTS Of the sample 240 (60%) were male and 160 (40%) were female. About 50% of women and 40% of men were 25-34 years old. More than 60% of men and 96% of women were married, while more than 50% of the participants had HIV-positive spouses at the time of study. According to the results, fertility desire was observed among more than 30% of female and 40% of male participants. Results of the in-depth interviews indicate that the participants are not satisfied with most of the existing services offered to address their sexual and reproductive health needs. CONCLUSION Despite the availability of services, most of sexual and reproductive health needs of the PLHIV are overlooked by the health system in Iran. Paying attention to sexual and reproductive health needs of PLHIV in Iran not only protects their right to live long and healthy lives, but also may prevent the transmission of HIV from the patients to others within the community.
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Affiliation(s)
- Saharnaz Nedjat
- School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Moazen
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farimah Rezaei
- Obstetrics and Gynecologist, Shahid Beheshti Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shayesteh Hajizadeh
- Department of Midwifery and Reproductive Health, Nursing and Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Maternal and Child Health, Nursing and Midwifery School, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Setayesh
- Regional Support Team for the Middle East and North Africa (RST-MENA), Cairo, Egypt
| | - Minoo Mohraz
- Iranian Research Center for HIV and AIDS, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Gooya
- Centre for Infectious Disease Control, Ministry of Health and Medical Education, Tehran, Iran
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19
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Mantell JE, Exner TM, Cooper D, Bai D, Leu CS, Hoffman S, Myer L, Moodley J, Kelvin EA, Constant D, Jennings K, Zweigenthal V, Stein ZA. Pregnancy intent among a sample of recently diagnosed HIV-positive women and men practicing unprotected sex in Cape Town, South Africa. J Acquir Immune Defic Syndr 2014; 67 Suppl 4:S202-9. [PMID: 25436819 PMCID: PMC4251915 DOI: 10.1097/qai.0000000000000369] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexual and reproductive health (SRH) services for HIV-positive women and men often neglect their fertility desires. We examined factors associated with pregnancy intent among recently diagnosed HIV-positive women (N = 106) and men (N = 91) who reported inconsistent condom use and were enrolled in an SRH intervention conducted in public sector HIV care clinics in Cape Town. METHODS Participants were recruited when receiving their first CD4 results at the clinic. All reported unprotected sex in the previous 3 months. Logistic regression identified predictors of pregnancy intent for the total sample and by gender. RESULTS About three fifths of men and one fifth of women reported intent to conceive in the next 6 months. In the full-sample multiple regression analysis, men [adjusted odds ratio (AOR = 6.62)] and those whose main partner shared intent to conceive (AOR = 3.80) had significantly higher odds of pregnancy intent; those with more years of education (AOR = 0.81) and more biological children (AOR = 0.62) had lower odds of intending pregnancy. In gender-specific analyses, partner sharing pregnancy intent was positively associated with intent among both men (AOR = 3.53) and women (AOR = 13.24). Among men, odds were lower among those having more biological children (AOR = 0.71) and those unemployed (AOR = 0.30). Among women, relying on hormonal contraception was negatively associated with intent (AOR = 0.08), and main partner knowing her HIV status (AOR = 5.80) was positively associated with intent to conceive. CONCLUSIONS Findings underscore the importance of providing integrated SRH services, and we discuss implications for clinical practice and care.
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Affiliation(s)
- Joanne E. Mantell
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY
| | - Theresa M. Exner
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY
| | - Diane Cooper
- Women's Health Research Unit, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa
| | - Dan Bai
- Departments of Biostatistics and Epidemiology, Joseph Mailman School of Public Health, Columbia University, New York, NY
| | - Cheng-Shiun Leu
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY
- Departments of Biostatistics and Epidemiology, Joseph Mailman School of Public Health, Columbia University, New York, NY
| | - Susie Hoffman
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY
- Departments of Biostatistics and Epidemiology, Joseph Mailman School of Public Health, Columbia University, New York, NY
| | - Landon Myer
- Division of Epidemiology and Biostatistics, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa
| | - Jennifer Moodley
- Women's Health Research Unit, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa
| | - Elizabeth A. Kelvin
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY
- Epidemiology and Biostatistics Program, The City University of New York School of Public Health, Hunter College, New York, NY
| | - Debbie Constant
- Women's Health Research Unit, University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa
| | - Karen Jennings
- City of Cape Town Department of Health, Cape Town, South Africa; and
| | - Virginia Zweigenthal
- University of Cape Town School of Public Health and Family Medicine, Cape Town, South Africa
| | - Zena A. Stein
- Division of Gender, Sexuality and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY
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20
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Moodley J, Cooper D, Mantell JE, Stern E. Health care provider perspectives on pregnancy and parenting in HIV-positive individuals in South Africa. BMC Health Serv Res 2014; 14:384. [PMID: 25212461 PMCID: PMC4167138 DOI: 10.1186/1472-6963-14-384] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 09/10/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Within the health system, limited attention is given to supporting the fertility and parenting desires on HIV-positive people. In this study, we explore health care providers' knowledge and perspectives on safer conception and alternate parenting strategies for HIV-positive people. METHODS Between November 2007 and January 2008, in-depth interviews were conducted with 28 health care workers involved in providing HIV and/or antiretroviral services at public sector clinics in Cape Town, South Africa. Views on sexual and reproductive health services, pregnancy, childbearing and parenting in HIV-positive men and women were explored using a semi-structured interview guide. Data were analyzed using a thematic approach. RESULTS Providers recognized the sexual and reproductive rights of HIV-positive individuals, but struggled with the tension between supporting these rights and concerns about spreading infection. Limited knowledge of safer conception methods constrained their ability to counsel and support clients in realizing fertility desires. Providers believed that parenting alternatives that do not maintain biological and cultural linkage are unlikely to be acceptable options. CONCLUSIONS Health care provider training and support is critical to providing comprehensive sexual and reproductive health care and meeting the fertility desires of HIV-positive people.
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Affiliation(s)
- Jennifer Moodley
- />Women’s Health Research Unit, School of Public Health & Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
| | - Diane Cooper
- />Women’s Health Research Unit, School of Public Health & Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
| | - Joanne E Mantell
- />HIV Center for Clinical and Behavioral Studies, Division of Gender, Health and Sexuality, New York State Psychiatric Institute and Columbia University, New York, NY USA
| | - Erin Stern
- />Women’s Health Research Unit, School of Public Health & Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
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21
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Muze RH. Parenting and child outcomes of HIV-infected African American mothers: a literature review. J Community Health Nurs 2014; 30:164-71. [PMID: 23879582 DOI: 10.1080/07370016.2013.806704] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Parenting young children while living with HIV is an important public health concern. This article reviews maternal HIV and the impact it has on the parenting experience of African American mothers. Because living with HIV has been considered a family illness, the Family Systems Model provided a framework for this article. The model demonstrated an important link between maternal HIV and its impact on the health and wellbeing of not only the mother and her children, but her parenting and family roles as well. Research has documented an association between maternal HIV and negative parent-child outcomes among African American mothers. I examined studies on parenting and child outcomes among African American mothers living with HIV. The review assists in conceptualizing parenting with HIV as an area of increasing importance in health services delivery to HIV-infected African American mothers who are caring for young children.
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Affiliation(s)
- Ruth H Muze
- Winston-Salem State University, Winston-Salem, NC 27110, USA.
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Nöstlinger C, Desjardins F, Dec J, Platteau T, Hasker E. Child desire in women and men living with HIV attending HIV outpatient clinics: Evidence from a European multicentre study. EUR J CONTRACEP REPR 2013; 18:251-63. [DOI: 10.3109/13625187.2013.801072] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kaida A, Matthews LT, Kanters S, Kabakyenga J, Muzoora C, Mocello AR, Martin JN, Hunt P, Haberer J, Hogg RS, Bangsberg DR. Incidence and predictors of pregnancy among a cohort of HIV-positive women initiating antiretroviral therapy in Mbarara, Uganda. PLoS One 2013; 8:e63411. [PMID: 23704906 PMCID: PMC3660357 DOI: 10.1371/journal.pone.0063411] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 04/04/2013] [Indexed: 11/19/2022] Open
Abstract
Objective Many people living with HIV in sub-Saharan Africa desire biological children. Implementation of HIV prevention strategies that support the reproductive goals of people living with HIV while minimizing HIV transmission risk to sexual partners and future children requires a comprehensive understanding of pregnancy in this population. We analyzed prospective cohort data to determine pregnancy incidence and predictors among HIV-positive women initiating antiretroviral therapy (ART) in a setting with high HIV prevalence and fertility. Methods Participants were enrolled in the Uganda AIDS Rural Treatment Outcomes (UARTO) cohort of HIV-positive individuals initiating ART in Mbarara. Bloodwork (including CD4 cells/mm3, HIV viral load) and questionnaires (including socio-demographics, health status, sexual behavior, partner dynamics, HIV history, and self-reported pregnancy) were completed at baseline and quarterly. Our analysis includes 351 HIV-positive women (18–49 years) who enrolled between 2005–2011. We measured pregnancy incidence by proximal and distal time relative to ART initiation and used multivariable Cox proportional hazards regression analysis (with repeated events) to identify baseline and time-dependent predictors of pregnancy post-ART initiation. Results At baseline (pre-ART initiation), median age was 33 years [IQR: 27–37] and median prior livebirths was four [IQR: 2–6]. 38% were married with 61% reporting HIV-positive spouses. 73% of women had disclosed HIV status to a primary sexual partner. Median baseline CD4 was 137 cells/mm3 [IQR: 81–207]. At enrolment, 9.1% (31/342) reported current pregnancy. After ART initiation, 84 women experienced 105 pregnancies over 3.8 median years of follow-up, yielding a pregnancy incidence of 9.40 per 100 WYs. Three years post-ART initiation, cumulative probability of at least one pregnancy was 28% and independently associated with younger age (Adjusted Hazard Ratio (AHR): 0.89/year increase; 95%CI: 0.86–0.92) and HIV serostatus disclosure to primary sexual partner (AHR: 2.45; 95%CI: 1.29–4.63). Conclusions Nearly one-third of women became pregnant within three years of initiating ART, highlighting the need for integrated services to prevent unintended pregnancies and reduce periconception-related risks for HIV-infected women choosing to conceive. Association with younger age and disclosure suggests a role for early and couples-based safer conception counselling.
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Nacius LA, Levison J, Minard CG, Fasser C, Davila JA. Serodiscordance and disclosure among HIV-positive pregnant women in the Southwestern United States. AIDS Patient Care STDS 2013; 27:242-7. [PMID: 23565927 DOI: 10.1089/apc.2012.0416] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The prevalence of HIV-positive pregnant women in relationships with HIV-negative men in the United States is unclear. The purpose of this study was to calculate the prevalence of HIV-positive pregnant women with a serodiscordant (HIV-negative) partner within a single clinic population, assess disclosure of their HIV status, and examine factors associated with disclosure. All HIV-positive pregnant women who received prenatal care at the Harris County Hospital District Women's Program at Northwest Health Center in Houston TX between 1/1/2006 and 4/1/2011 were identified. Data were obtained from electronic medical records. Prevalence of serodiscordance and disclosure was calculated, and predictors of disclosure were evaluated. We identified 212 HIV-positive pregnant women. About 40% had a serodiscordant partner, and 34% had a partner with an unknown HIV status. Disclosure occurred in over 90% of women with a serodiscordant partner and in 68% of women with partners whose HIV status was unknown. Among pregnant women who knew their HIV status prior to the current pregnancy and had a serodiscordant partner, 92% reported disclosing their status prior to conception. Our data indicated that serodiscordant relationships are common in our clinic population. Suboptimal disclosure rates were observed, especially among women who have a partner with an unknown HIV status. Further research is needed to evaluate the prevalence of serodiscordance and disclosure in other United States populations.
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Affiliation(s)
- Lori A. Nacius
- Physician Assistant Program, Baylor College of Medicine, Houston, Texas
| | - Judy Levison
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Charles G. Minard
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Carl Fasser
- Physician Assistant Program, Baylor College of Medicine, Houston, Texas
| | - Jessica A. Davila
- Houston Health Services Research and Development (HSR&D) Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
- Department of Medicine, Baylor College of Medicine, Houston, Texas
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Matthews LT, Smit JA, Cu-Uvin S, Cohan D. Antiretrovirals and safer conception for HIV-serodiscordant couples. Curr Opin HIV AIDS 2013; 7:569-78. [PMID: 23032734 DOI: 10.1097/coh.0b013e328358bac9] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Many men and women living with HIV and their uninfected partners attempt to conceive children. HIV-prevention science can be applied to reduce sexual transmission risk while respecting couples' reproductive goals. Here we discuss antiretrovirals as prevention in the context of safer conception for HIV-serodiscordant couples. RECENT FINDINGS Antiretroviral therapy (ART) for the infected partner and pre-exposure prophylaxis (PrEP) for the uninfected partner reduce the risk of heterosexual HIV transmission. Several demonstration projects suggest the feasibility and acceptability of antiretroviral (ARV)s as periconception HIV-prevention for HIV-serodiscordant couples. The application of ARVs to periconception risk reduction may be limited by adherence. SUMMARY For male-infected (M+F-) couples who cannot access sperm processing and female-infected (F+M-) couples unwilling to carry out insemination without intercourse, ART for the infected partner, PrEP for the uninfected partner, combined with treatment for sexually transmitted infections, sex limited to peak fertility, and medical male circumcision (for F+M couples) provide excellent, well tolerated options for reducing the risk of periconception HIV sexual transmission.
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Affiliation(s)
- Lynn T Matthews
- Massachusetts General Hospital, Center for Global Health and Division of Infectious Disease, Boston, USA.
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Loutfy MR, Wu W, Letchumanan M, Bondy L, Antoniou T, Margolese S, Zhang Y, Rueda S, McGee F, Peck R, Binder L, Allard P, Rourke SB, Rochon PA. Systematic review of HIV transmission between heterosexual serodiscordant couples where the HIV-positive partner is fully suppressed on antiretroviral therapy. PLoS One 2013; 8:e55747. [PMID: 23418455 PMCID: PMC3572113 DOI: 10.1371/journal.pone.0055747] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 12/31/2012] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The risk of sexual HIV transmission in serodiscordant couples when the HIV-positive partner has full virologic suppression on combination antiretroviral therapy (cART) is debated. This study aims to systematically review observational studies and randomized controlled trials (RCTs), evaluating rates of sexual HIV transmission between heterosexual serodiscordant couples when the HIV-positive partner has full suppression on cART. METHODS AND FINDINGS We searched major bibliographic databases to November 2012 for relevant observational studies and RCTs without language restrictions. Conference proceedings, key journals and bibliographies were also searched. Studies reporting HIV transmission rates, cART histories and viral loads of the HIV-positive partners were included. Two reviewers extracted methodologic characteristics and outcomes. Of 20,252 citations, 3 studies met all eligibility criteria with confirmed full virologic suppression in the HIV-positive partner. We included 3 additional studies (2 cohort studies, 1 RCT) that did not confirm viral suppression in the HIV-positive partner at transmission in a secondary meta-analysis. Methodologic quality was reasonable. The rate of transmission in the 3 studies confirming virologic suppression was 0 per 100 person-years (95% CI = 0-0.05), with low heterogeneity (I(2) = 0%). When we included the 3 studies that did not confirm virologic suppression, the rate of transmission was 0.14 per 100 person-years (95%CI = 0.04-0.31) (I(2) = 0%). In a sensitivity analysis including all 6 studies, the rate of transmission was 0 per 100 person-years (95%CI = 0-0.01) after omitting all transmissions with known detectable or unconfirmed viral loads, as full suppression in these cases was unlikely. Limitations included lack of data on same-sex couples, type of sexual intercourse (vaginal vs. anal), direction of HIV transmission, exact viral load at the time of transmission, sexually transmitted infections (STI) rates, and extent of condom use. CONCLUSIONS Our findings suggest minimal risk of sexual HIV transmission for heterosexual serodiscordant couples when the HIV-positive partner has full viral suppression on cART with caveats regarding information on sexual intercourse type, STIs, and condom use. These findings have implications when counseling heterosexual serodiscordant couples on sexual and reproductive health. More research is needed to explore HIV transmission risk between same-sex couples.
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Affiliation(s)
- Mona R Loutfy
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Canada.
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Reproductive decision-making and periconception practices among HIV-positive men and women attending HIV services in Durban, South Africa. AIDS Behav 2013; 17:461-70. [PMID: 22038045 PMCID: PMC3560938 DOI: 10.1007/s10461-011-0068-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Understanding reproductive decisions and periconception behavior among HIV-discordant couples is important for designing risk reduction interventions for couples who choose to conceive. In-depth interviews were conducted to explore reproductive decision-making and periconception practices among HIV-positive women with recent pregnancy (n = 30), and HIV-positive men (n = 20), all reporting partners of negative or unknown HIV-status, and attending HIV services in Durban, South Africa. Transcripts were coded for categories and emergent themes. Participants expressed strong reasons for having children, but rarely knew how to reduce periconception HIV transmission. Pregnancy planning occurred on a spectrum ranging from explicitly intended to explicitly unintended, with many falling in between the two extremes. Male fertility desire and misunderstanding serodiscordance contributed to HIV risk behavior. Participants expressed openness to healthcare worker advice for safer conception and modified risk behavior post-conception, suggesting the feasibility of safer conception interventions which may target both men and women and include serodiscordance counseling and promotion of contraception.
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Differences in the Nonuse of any Contraception and Use of Specific Contraceptive Methods in HIV Positive and HIV Negative Rwandan Women. AIDS Res Treat 2012; 2012:367604. [PMID: 23304468 PMCID: PMC3533450 DOI: 10.1155/2012/367604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 10/25/2012] [Indexed: 11/21/2022] Open
Abstract
Contraception can reduce the dual burden of high fertility and high HIV prevalence in sub-Sahara Africa, but significant barriers remain regarding access and use. We describe factors associated with nonuse of contraception and with use of specific contraceptive methods in HIV positive and HIV negative Rwandan women. Data from 395 HIV-positive and 76 HIV-negative women who desired no pregnancy in the previous 6 months were analyzed using univariate and multivariate logistic regression models to identify clinical and demographic characteristics that predict contraceptive use. Differences in contraceptive methods used were dependent on marital/partner status, partner's knowledge of a woman's HIV status, and age. Overall, condoms, abstinence, and hormonal methods were the most used, though differences existed by HIV status. Less than 10% of women both HIV+ and HIV− used no contraception. Important differences exist between HIV-positive and HIV-negative women with regard to contraceptive method use that should be addressed by interventions seeking to improve contraceptive prevalence.
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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. REPRODUCTIVE 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: 3.8] [Reference Citation Analysis] [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.
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Zamudio-Haas S, Mudekunye-Mahaka I, Lambdin BH, Dunbar MS. If, when and how to tell: a qualitative study of HIV disclosure among young women in Zimbabwe. REPRODUCTIVE HEALTH MATTERS 2012. [DOI: 10.1016/s0968-8080(12)39637-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Between a rock and a hard place: stigma and the desire to have children among people living with HIV in northern Uganda. J Int AIDS Soc 2012; 15:17421. [PMID: 22713256 PMCID: PMC3499804 DOI: 10.7448/ias.15.2.17421] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 02/18/2012] [Accepted: 05/04/2012] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND HIV-related stigma, among other factors, has been shown to have an impact on the desire to have children among people living with HIV (PLHIV). Our objective was to explore the experiences of HIV-related stigma among PLHIV in post-conflict northern Uganda, a region of high HIV prevalence, high infant and child mortality and low contraception use, and to describe how stigma affected the desires of PLHIV to have children in the future. METHODS Semi-structured interviews were conducted with 26 PLHIV in Gulu district, northern Uganda. The interviews, conducted in Luo, the local language, were audio recorded, transcribed and then translated into English. Thematic data analysis was undertaken using NVivo8 and was underpinned by the "Conceptual Model of HIV/AIDS Stigma". RESULTS HIV-related stigma continues to affect the quality of life of PLHIV in Gulu district, northern Uganda, and also influences PLHIV's desire to have children. PLHIV in northern Uganda continue to experience stigma in various forms, including internal stigma and verbal abuse from community members. While many PLHIV desire to have children and are strongly influenced by several factors including societal and cultural obligations, stigma and discrimination also affect this desire. Several dimensions of stigma, such as types of stigma (received, internal and associated stigma), stigmatizing behaviours (abusing and desertion) and agents of stigmatization (families, communities and health systems), either directly, or indirectly, enhanced or reduced PLHIV's desire to have more children. CONCLUSIONS The social-cultural context within which PLHIV continue to desire to have children must be better understood by all health professionals who hope to improve the quality of PLHIV's lives. By delineating the stigma process, the paper proposes interventions for reducing stigmatization of PLHIV in northern Uganda in order to improve the quality of life and health outcomes for PLHIV and their children.
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Finocchario-Kessler S, Bastos FI, Malta M, Anderson J, Goggin K, Sweat M, Dariotis J, Bertoni N, Kerrigan D. Discussing childbearing with HIV-infected women of reproductive age in clinical care: a comparison of Brazil and the US. AIDS Behav 2012; 16:99-107. [PMID: 21359541 DOI: 10.1007/s10461-011-9906-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite long term access to highly active antiretroviral therapy in Brazil and the US, little is known about women's communication with their HIV provider regarding childbearing or the unmet need for reproductive counseling. We utilized identical survey questions to collect data from HIV-infected women of reproductive age in Rio de Janeiro (n = 180) and Baltimore (n = 181). We conducted univariate analyses to compare findings between samples of women and multivariate logistic regression to determine factors associated with childbearing desires, childbearing intentions, and provider communication among the combined sample of women (n = 361). Over one-third of women in Rio de Janeiro and nearly one-half of women in Baltimore reported the desire for future childbearing. Nevertheless, the majority of women in clinical care had not discussed future childbearing with their HIV provider. Even in countries with an advanced approach to HIV care, we found low and inadequate communication between providers and female patients about childbearing.
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Affiliation(s)
- Sarah Finocchario-Kessler
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Chadwick RJ, Mantell JE, Moodley J, Harries J, Zweigenthal V, Cooper D. Safer conception interventions for HIV-affected couples: implications for resource-constrained settings. TOPICS IN ANTIVIRAL MEDICINE 2011; 19:148-155. [PMID: 22156217 PMCID: PMC6148878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 06/28/2011] [Indexed: 05/31/2023]
Abstract
Developing and testing safer conception methods that reduce HIV transmission to HIV-seronegative partners in serodiscordant couples and reduce superinfection in HIV-seroconcordant couples is a crucial but often unaddressed component of HIV prevention programs. Most research has focused on developed-world settings, where "high-technology" assisted reproduction techniques are used for HIV-serodiscordant couples in which the male is HIV-infected. There is a dearth of research on safer conception methods for HIV-seropositive women and "low-technology" harm-reduction strategies for HIV-affected couples, including vaginal insemination for HIV-seropositive women and natural conception methods for HIV-seroconcordant and -serodiscordant couples. This review summarizes international studies of safer conception interventions for HIV-affected couples, with a focus on feasibility in public-sector health settings where assisted reproductive technology is not readily available. Given that such low-technology options are feasible in most settings, well-designed, prospective interventions offering low-technology safer conception methods need to be developed and tested.
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Affiliation(s)
- Rachelle J Chadwick
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, South Africa
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Abstract
Andrew Gibbs and colleagues discuss the African Women's Protocol, a framework for ensuring reproductive rights are supported throughout the continent and for supporting interventions to improve women's reproductive health, including the MDGs.
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Affiliation(s)
| | - Andrew Gibbs
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Samantha Willan
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
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