Research was conducted with 36 women living with HIV in Cape Town, South Africa, regarding their decision-making about, and experiences with, abortion of unwanted pregnancies in the public health sector. Abortion intentions and decisions were explored by investigating influencing factors; knowledge of abortion policy and public health sector services; and abortion perceptions and experiences. Findings reveal that many women face censure both for becoming pregnant and terminating a pregnancy, including by family, partners, community members and healthcare providers. Data suggest that abortion may be more stigmatised than HIV despite South Africa's liberal abortion law. Generally, however, study participants were satisfied with the abortion care received. Most would advise women living with HIV to think carefully about abortion, but to make a decision in their own best interests, including only seeking care early in pregnancy from an accredited clinic. Study implications include a need to integrate information and counselling on safe legal abortion within sexual and reproductive health services, especially in efforts to integrate sexual and reproductive health into HIV care, and to forge greater linkages between HIV and abortion services more generally to ensure continuity in follow-up of care for women.
HIV-positive women's abortion decisions were explored by: (i) investigating influencing factors; (ii) determining knowledge of abortion policy and public health services; and (iii) exploring abortion experiences. In-depth interviews were held with 24 HIVpositive women (15 had an abortion; 9 did not), recruited at public health facilities in Cape Town, South Africa. Negative perceptions towards HIV-positive pregnant women were reported. Women wanted abortions due to socio-economic hardship in conjunction with HIV-positive status. Respondents were generally aware that women in South Africa had a right to free abortions in public health facilities. Both positive and negative abortion experiences were described. Respondents reported no discrimination by providers due to their HIV-positive status. Most respondents reported not using contraceptives, while describing their pregnancies as 'unexpected' . The majority of women who had abortions wanted to avoid another one, and would encourage other HIV-positive women to try to avoid abortion. However, most felt abortions were acceptable for HIV-positive women in some circumstances. Data suggested that stigma and discrimination affect connections between abortion, pregnancy and HIV/AIDS, and that abortion may be more stigmatised than HIV/AIDS. Study results provide important insights, and any revision of reproductive health policy, services, counselling for abortion and HIV/AIDS care should address these issues. Keywords: HIV/AIDS, HIV RésuméLa décision d'avorter des femmes séropositives ont été étudiées: (i) en enquêtant sur les facteurs d'influence ; (ii) en déterminant les connaissances de la politique en matière d'avortement et des services de santé publique; et (iii) en étudiant les expériences d'avortement. Des entretiens approfondis ont été réalisés auprès de 24 femmes séropositives (dont 15 avaient subi un avortement et 9 non), recrutées dans des structures de santé publique du Cap, en Afrique du Sud. Des perceptions négatives des femmes enceintes séropositives ont été rapportées. Les femmes souhaitaient avoir recours à l'avortement du fait de leurs difficultés socioéconomiques doublées de leur statut sérologique positif. Les interrogées savaient généralement qu' en Afrique du Sud, les femmes avaient le droit de se faire avorter gratuitement dans les structures de santé publique. Des expériences d'avortement aussi bien positives que négatives ont été décrites. Les interrogées ont indiqué que les prestataires de services ne les discriminaient pas du fait de leur statut sérologique positif. La plupart des interrogées ont indiqué ne pas utiliser de contraception, mais décrivaient leurs grossesses comme 'non prévues' . La majorité des femmes ayant subi un avortement souhaitaient en éviter un autre, et affirmaient souhaiter encourager les autres femmes séropositives à essayer d' éviter de se faire avorter. Cependant, la majorité d' entre elles considéraient que les avortements étaient acceptables pour les femmes séropositives dans certaines circonstances. Les d...
Women in Africa are facing discrimination and challenges in relation to HIV/AIDS, particularly regarding their sexual and reproductive health care. This includes a lack of information regarding HIV and pregnancy, difficulties with contraceptive use, negative attitudes towards childbearing, and problems in accessing safe legal abortions. This paper addresses these issues in South Africa, based on an interview study with eight key informants and a literature review. The South African experience should inform policy-making and programmes in relation to HIV and reproductive health care in other African countries. femmes africaines font face à la discrimination et aux défis par rapport au VIH/SIDA, surtout quand il s'agit des services de la santé sexuelle et de reproduction. Ajouté à ceci est le manque de renseignement concernant le VIH et la grossesse, les difficultés liées à l'emploi des contraceptifs, les attitudes négatives envers la maternité et les problèmes d'accès aux avortements légaux et sans danger. Cet article étudie ces problèmes en Afrique du Sud en se fondant sur une étude effectuée à travers des intérieurs, à l'aide des huit principaux interviews et une analyse de la littérature. L'expérience sud-africaine devrait servir d'exemple pour la formulation des politiques et des programmes par rapport au VIH et les services de santé de reproduction dans d'autres pays africains. (Rev Afr Santé Reprod 2004; 8[1]:92-98)
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