With availability of antiretroviral treatments, HIV is increasingly recognised as a chronic disease people live with for many years. This paper critically reviews the current literature on fertility desires and reproductive intentions among people living with HIV/AIDS (PLHIV) and critiques the theoretical frameworks and methodologies used. A systematic review was conducted using electronic databases: ISI Web of Knowledge, Science Direct, Proquest, Jstor and CINAHL for articles published between 1990 and 2008. The search terms used were fertility desire, pregnancy, HIV, reproductive decision making, reproductive intentions, motherhood, fatherhood and parenthood. Twenty-nine studies were reviewed. Fertility desires were influenced by a myriad of demographic, health, stigma-associated and psychosocial factors. Cultural factors were also important, particularly in Sub-Saharan Africa and Asia. Future research that examines fertility desires among PLHIV should include cultural beliefs and practices in the theoretical framework in order to provide a holistic understanding and to enable development of services that meet the reproductive needs of PLHIV.
BackgroundThe International Conference on Population Development held in Cairo in 1994 identified the importance of male involvement in reproductive health programs. Since then, there has been an increase in reproductive health initiatives that target both men and women in an attempt to fulfill the 5th Millenium Development Goal. Yet, while the benefits of male involvement have been acknowledged, there continues to be a challenge in creating a space for and engaging men in maternal health. This is problematic due to the role of men as the head of the household in many countries, especially developing countries, which suffer from higher rates of maternal mortality. Furthermore, men are important as partners, fathers and health care professionals and as such it is important to involve and engage with men in maternal health education, and antenatal care.MethodsThe purpose of this study undertaken in two rural villages in southeastern Uganda, was twofold: firstly to understand men’s current participation in antenatal, pregnancy care and childbirth and secondly to gain insight into both men and women’s attitudes toward increased male involvement. Focus group discussions and semi-structured questionnaires were used to collect information from 35 men and women. The women were either pregnant or had been involved in a birth experience in the past 3 years and the men had wives who were pregnant or had given birth recently.ResultsMen interviewed in the two villages believed that issues related to pregnancy and childbirth were the domain of women. Involvement tended to be confined (to removed) strictly to traditional gender roles, with men’s main responsibility being provision of funds. The women, on the other hand, were interested in receiving more support from their husband through planning, attendance to antenatal care and physical presence in the vicinity of where the birth was taking place.ConclusionThis cross-sectional study has highlighted the space for increased male involvement and participation in maternal health, proposed recommendations and the need for community health education directed at men that engages them in this important area.
This study examined the relations between school climate variables and students’ feeling of wellbeing, life satisfaction, ethnic identity, moral identity and resilience. Furthermore, the study also examined the interrelationships between these five outcome variables. Six aspects of the school climate were measured: teacher support, peer connectedness, school connectedness, affirming diversity, rule clarity and reporting and seeking help. The participants included 2202 students, the data from whom included 2122 cases that were complete and usable (1058 boys and 1059 girls) from six public high schools in Perth, Western Australia. These data were analysed by means of structural equation modelling (SEM) analysis. All six school climate factors were related to student wellbeing. These relations were primarily indirect (with the exception of teacher support, school connectedness and affirming diversity which had a direct influence), mediated through the students’ sense of ethnic and moral identity, resilience and life satisfaction.
BackgroundNorthern Uganda experienced severe civil conflict for over 20 years and is also a region of high HIV prevalence. This study examined knowledge of, access to, and factors associated with use of family planning services among people living with HIV (PLHIV) in this region.MethodsBetween February and May 2009, a total of 476 HIV clinic attendees from three health facilities in Gulu, Northern Uganda, were interviewed using a structured questionnaire. Semi-structured interviews were conducted with another 26 participants. Factors associated with use of family planning methods were examined using logistic regression methods, while qualitative data was analyzed within a social-ecological framework using thematic analysis.ResultsThere was a high level of knowledge about family planning methods among the PLHIV surveyed (96%). However, there were a significantly higher proportion of males (52%) than females (25%) who reported using contraception. Factors significantly associated with the use of contraception were having ever gone to school [adjusted odds ratio (AOR) = 4.32, 95% confidence interval (CI): 1.33-14.07; p = .015], discussion of family planning with a health worker (AOR = 2.08, 95% CI: 1.01-4.27; p = .046), or with one's spouse (AOR = 5.13, 95% CI: 2.35-11.16; p = .000), not attending the Catholic-run clinic (AOR = 3.67, 95% CI: 1.79-7.54; p = .000), and spouses' non-desire for children (AOR = 2.19, 95% CI: 1.10-4.36; p = .025). Qualitative data revealed six major factors influencing contraception use among PLHIV in Gulu including personal and structural barriers to contraceptive use, perceptions of family planning, decision making, covert use of family planning methods and targeting of women for family planning services.ConclusionsMultilevel, context-specific health interventions including an integration of family planning services into HIV clinics could help overcome some of the individual and structural barriers to accessing family planning services among PLHIV in Gulu. The integration also has the potential to reduce HIV incidence in this post-conflict region.
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