Attitudes of women and men living with HIV and their healthcare providers towards pregnancy and abortion by HIV-positive women in Nigeria and Zambia

Knowledge, attitude, practices and associated factors of family planning among women living with hiv at the university of Gondar specialized hospital: a cross sectional study

INTRODUCTION

HIV/AIDS poses a significant health challenge in sub-Saharan African countries, with a disproportionate impact on women of reproductive age. The disparities in knowledge, attitudes, and practices related to family planning among women living with HIV can be intricate and multi-faceted. This study aimed to assess the knowledge, attitude, practice, and associated factors regarding family planning among the women living with HIV at the University of Gondar specialized hospital, Gondar, Ethiopia.

METHOD

A cross-sectional study was carried out at the University of Gondar Teaching Referral Hospital, focusing on HIV-positive women of reproductive age who visited the ART unit from July 8-28, 2022. Data collection involved the use of pre-tested, structured questionnaires administered through interviews. The gathered data were entered into the electronic Kobo Collect platform and subsequently exported for analysis using SPSS version 26. Descriptive summaries, including frequencies, means, and percentages, were presented through tables and figures. Logistic regression was employed to identify potential predictors, presenting adjusted odds ratios with a 95% confidence interval and a significance level set at a P-value of 0.05.

RESULTS

A total of 328 study participants were included. About 93% of the study population had good knowledge about modern contraceptives, and about 94% of the study population had good knowledge about safer conception. Only 30.2% of the study population had knowledge of the dual contraceptive method. The attitude and practice of women towards family planning (FP) were 71.0% and 55.8%, respectively. The study revealed that the most commonly employed contraceptive method was injectable contraceptives, constituting 34.2% of usage. Having one and a greater number of children (AOR = 2.25, 95% CI: 1.10, 4.49), having discussions on fertility plans with healthcare providers (AOR = 2.20, 95% CI: 1.02, 4.761), and having good family planning practices (AOR = 2.15, 95% CI: 1.19, 3.87) were significantly associated with the attitude toward family planning. Married women (AOR = 1.88, 95% CI = 1.11, 3.1), able to read and write (AOR = 2.12, 95% CI:1.04,4.32), college and above educational level (AOR = 4.51, 95% CI:1.93,10.87), had discussion on fertility plan with healthcare providers (AOR = 5.09, 95% CI: 1.96, 13.24), knowledge about dual method (AOR = 1.95, CI: 1.08, 3.50), and knowledge about modern contraceptive methods (AOR = 7.24, 95% CI: 1.56, 33.58) were significantly associated with good practice of family planning.

CONCLUSION

Women living with HIV exhibited notably high levels of knowledge regarding modern contraceptive methods and safer conception. The knowledge of the dual method was low. More than half of the study population had good practice in family planning. More than two-thirds of HIV-positive reproductive-age women had a good attitude about family planning. Having one or a greater number of children, having a discussion on a fertility plan with a healthcare provider, and having a good practice of family planning were significantly associated with a good attitude toward family planning. Married women, education status, discussions on fertility plans with healthcare providers, knowledge about dual methods, and knowledge about modern contraceptive methods were significantly associated with good family planning practices. The stakeholders should design interventions based on the aforementioned factors to improve the attitude and practice of family planning.

Identifying Profiles of Support for Legal Abortion Services in Zambia: A Latent Class Analysis

Relative to neighboring countries, Zambia has among the most progressive abortion policies, but numerous sociopolitical constraints inhibit knowledge of pregnancy termination rights and access to safe abortion services. Multistage cluster sampling was used to randomly select 1,486 women aged 15-44 years from households in three provinces. We used latent class analysis (LCA) to partition women into discrete groups based on patterns of endorsed support for legalized abortion on six socioeconomic and health conditions. Predictors of probabilistic membership in latent profiles of support for legal abortion services were identified through mixture modeling. A three-class solution of support patterns for legal abortion services emerged from LCA: (1) legal abortion opponents (∼58 percent) opposed legal abortion across scenarios; (2) legal abortion advocates (∼23 percent) universally endorsed legal protections for abortion care; and (3) conditional supporters of legal abortion (∼19 percent) only supported legal abortion in circumstances where the pregnancy threatened the fetus or mother. Advocates and Conditional supporters reported higher exposure to family planning messages compared to opponents. Relative to opponents, advocates were more educated, and Conditional supporters were wealthier. Findings reveal that attitudes towards abortion in Zambia are not monolithic, but women with access to financial/social assets exhibited more receptive attitudes towards legal abortion.

Demography of remarriage and fertility desire among women receiving antiretroviral therapy in South West Nigeria

Background: In view of sociocultural norms surrounding marriage and childbearing in South West Nigeria, fertility desire may be stronger among remarried women living with HIV. This article describes the characteristics of remarriage and its relationship to fertility desire.Method: A cross-sectional study was conducted among HIV-positive women aged 18-49 years at the Antiretroviral Treatment (ART) clinic, College of Medicine/University College Hospital, Ibadan, Nigeria between November and December 2015. Data were analysed using descriptive statistics and generalised linear models.Results: Overall, 123 (17.3%) of 711 women had experienced remarriage. Significant factors among remarried women were a lack of formal education (OR_adj = 3.35, CI: 1.46-7.72); polygamous family (OR_adj = 2.65, CI: 1.71-4.12), and serodiscordant union (OR_adj = 1.97, CI: 1.14-3.41). Fertility desire was expressed by 410 women (57.7%). After controlling for demographic, socio-economic, and HIV-care characteristics, remarried women were 2.5 times as likely to have fertility desire compared to their counterparts who never remarried (OR_adj = 2.49, CI: 1.43-4.33). Younger age was significantly associated with higher odds of fertility desire. Other factors negatively associated with fertility desire were education (OR_adj = 0.30, CI: 0.12-0.74) and number of surviving children (OR_adj = 0.28, CI: 0.22-0.34).Conclusion: HIV-care and treatment programmes need to pay attention to reproductive concerns, especially among women in second and higher order marriages.

Exploring the roles of men and masculinities in abortion and emergency contraception pathways, Ghana: a mobile phone-based mixed-methods study protocol

INTRODUCTION

Global commitments have established goals of achieving universal sexual and reproductive health and rights (SRHR) access, but critical obstacles remain. Emergency contraception and induced abortion are overlooked in policy and research. Men's roles in the SRHR of others are significant, particularly as obstacles to universal SRHR. Evidence on gender, masculinities and SRHR is essential to understand and reduce the barriers faced by individuals seeking to avoid the conception or continuation of a pregnancy.

METHODS AND ANALYSIS

This study aims to understand men's masculinities and their relationships with emergency contraception and abortion. The protocol presents a multimethod study of men aged over 18 years in James Town, Accra, Ghana. In response to the COVID-19 pandemic, the research will use two mobile-based methods: a survey and in-depth interviews. Using respondent-driven sampling, an estimated 789 men will be recruited to participate in the survey, asking questions on their knowledge, attitude, behaviours and roles in emergency contraception and abortion. In-depth interviews focused on constructions of masculinity will be conducted with a purposive sample of men who participated in the survey. Data will be analysed concurrently using multiple regression analyses of quantitative data and abductive analysis of qualitative data.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the London School of Economics and Political Science and the Ghana Health Service. The findings in this study will: engage with emerging research on masculinities and SRHR in Ghana and elsewhere; offer methodological insight for future research; and provide evidence to inform interventions to reduce obstacles for emergency contraception and abortion care seekers. Dissemination will occur at all levels-policy, academic, community-including multiple academic articles, policy briefs, workshops and presentations, conference papers, and theatre/radio-based performances of key messages.

Health workers' knowledge of safer conception and attitudes toward reproductive rights of HIV-infected couples in Kano, Nigeria

BACKGROUND

The restriction of reproductive rights of HIV-positive couples in low-resource settings could be related to the attitudes and skills of health workers. We assessed health workers' knowledge of safer conception and their attitudes toward the reproductive rights of HIV-positive couples in a tertiary hospital in Nigeria.

METHODS

A cross-section of health workers (n=294) was interviewed using structured questionnaires. Knowledge and attitude scores were analyzed. Logistic regression was employed to generate adjusted odds ratios (AORs) for predictors of attitude.

RESULTS

Safer conception methods mentioned by respondents included timed unprotected intercourse with (27.9%) and without antiretroviral pre-exposure prophylaxis (37.4%), in vitro fertilization plus intracytoplasmic sperm injection (26.5%), and sperm washing and intrauterine insemination (24.8%). The majority (94.2%) of health workers acknowledged the reproductive rights of HIV-infected persons, although (64.6%) strongly felt that HIV-infected couples should have fewer children. Health workers reported always/nearly always counseling their patients on HIV transmission risks (64.1%) and safer conception (59.2% and 48.3% for females and males, respectively) (p<0.05). Among health workers, being older (30-39 vs <30 y) (AOR=1.33, 95% CI=1.13-2.47), married (AOR=2.15, 95% CI=1.17-5.58) and having a larger HIV-positive daily caseload (20-49 vs <20) (AOR=1.98, 95% CI=1.07-3.64) predicted positive attitude towards reproductive rights of HIV-affected couples.

CONCLUSIONS

Health workers had limited knowledge of safer conception methods, but were supportive of the reproductive rights of HIV-positive couples. Health workers in Nigeria require training to effectively counsel couples on their reproductive rights, risks and options.

Women's knowledge and attitudes surrounding abortion in Zambia: a cross-sectional survey across three provinces

OBJECTIVES

In Zambia, despite a relatively liberal legal framework, there remains a substantial burden of unsafe abortion. Many women do not use skilled providers in a well-equipped setting, even where these are available. The aim of this study was to describe women's knowledge of the law relating to abortion and attitudes towards abortion in Zambia.

SETTING

Community-based survey in Central, Copperbelt and Lusaka provinces.

PARTICIPANTS

1484 women of reproductive age (15-44 years).

PRIMARY AND SECONDARY OUTCOME MEASURES

Correct knowledge of the legal grounds for abortion, attitudes towards abortion services and the previous abortions of friends, family or other confidants. Descriptive statistics and multivariable logistic regression were used to analyse how knowledge and attitudes varied according to sociodemographic characteristics.

RESULTS

Overall, just 16% (95% CI 11% to 21%) of women of reproductive age correctly identified the grounds for which abortion is legal. Only 40% (95% CI 32% to 45% of women of reproductive age knew that abortion was legally permitted in the extreme situation where the pregnancy threatens the life of the mother. Even in urban areas of Lusaka province, only 55% (95% CI 41% to 67%) of women knew that an abortion could legally take place to save the mother's life. Attitudes remain conservative. Women with correct knowledge of abortion law in Zambia tended to have more liberal attitudes towards abortion and access to safe abortion services. Neither correct knowledge of the law nor attitudes towards abortion were associated with knowing someone who previously had an induced abortion.

CONCLUSIONS

Poor knowledge and conservative attitudes are important obstacles to accessing safe abortion services. Changing knowledge and attitudes can be challenging for policymakers and public health practitioners alike. Zambia could draw on its previous experience in dealing with its large HIV epidemic to learn cross-cutting lessons in effective mass communication on what is a difficult and sensitive issue.

PREVALENCE AND FACTORS ASSOCIATED WITH PATERNITY INTENTION AMONG MEN LIVING WITH HIV/AIDS IN FORTALEZA, CEARÁ

The aim of this study was to analyze the prevalence and factors associated with paternity intention in 162 men with HIV/AIDS in Fortaleza, Ceará. Data were collected from June to September 2012 using a questionnaire in reference outpatient centers. Pearson's chi-squared test and logistic regression model were used for analysis. In all, 41.4% of men had the intention to have children. Age <35 years (p<0.001), desire to have children before diagnosis (p<0.001), relationship for less than five years (p=0.022), partner's desire to have children (p<0.001), having no children with the partner (p=0.047), partner without children (p=0.032) and therapy for more than three years (p=0.030) presented significant statistical association with men's desire to have children. In the multivariate analysis, the desire to have children before diagnosis (p=0.004; OR:9.81; CI:1.84-52.20) and partner's desire to have children (p<0.001; OR:9.72; CI:3.48-27.12) remained statistically significant. Many men still intend to be fathers even after the HIV/AIDS diagnosis.

Bucking social norms: examining anomalous fertility aspirations in the face of HIV in Lusaka, Zambia

In settings of high fertility and high HIV prevalence, individuals are making fertility decisions while simultaneously trying to avoid or manage HIV. We sought to increase our understanding of how individuals dually manage HIV risk while attempting to achieve their fertility goals as part of the project entitled HIV Status and Achieving Fertility Desires conducted in Zambia in 2011. Using multivariate regression to predict fertility patterns based on socio-demographic characteristics for respondents from facility-based and community-based surveys, we employed Anomalous Case Analysis (ACA) whereby in-depth interview respondents were selected from the groups of outliers amongst the survey respondents who reported lower or higher fertility preferences than predicted as well as those who adhered to predicted patterns, and lived in Lusaka (n=45). All of the facility-based respondents were HIV-positive. We utilize the Theory of Conjunctural Action (TCA) to categorize domains of influence on individuals' preferences and behavior. Both community-based and facility-based right-tail respondents (outliers whose fertility intentions indicated that they wanted a/nother child when we predicted that they did not) expressed comparatively less control over their fertility and gave more weight to pressures from others to continue childbearing. Partner communication about fertility desires was greater among left-tail respondents (outliers whose fertility intentions indicated that they did not want a/nother child when we predicted that they did). HIV-positive right-tail respondents were more likely to see anti-retroviral therapies (ARTs) which prevent mother to child transmission of HIV as highly effective, mitigating inhibitions to further childbearing. Drug interactions between ARTs and contraceptives were identified as a limitation to HIV-positive individuals' contraceptive options on both sides of the distribution. Factors that should be taken into account in the future to understand fertility behavior in high HIV-prevalent settings include couples' communication around fertility and perception of the efficacy of ARTs.