Factors influencing the experience of sexual and reproductive healthcare for female adolescents with perinatally-acquired HIV: a qualitative case study

Abstract

BackgroundYoung people living with perinatally-acquired HIV require age-appropriate support regarding sex and relationships as they progress towards adulthood. HIV affects both genders but evidence suggests that young women are particularly vulnerable to sexual abuse and more prone to engaging in sexual behaviours to meet their daily survival needs. This can result in poor sexual and reproductive health (SRH) outcomes. HIV services in Malawi provide support for young women’s HIV-related clinical needs, but it is unclear whether there is sufficient provision for their SRH needs as they become adults. This paper explores the sex and relationship experiences of young women growing up with perinatally-acquired HIV in order to understand how to improve SRH care and associated outcomes.MethodsA qualitative case study approach was adopted in which each ‘case’ comprised a young woman (15–19 years) with perinatally acquired HIV, a nominated caregiver and service provider. Participants were purposively selected from three multidisciplinary centres providing specialised paediatric/adolescent HIV care in Malawi. Data was collected for 14 cases through in-depth interviews (i.e. a total of 42 participants) and analysed using within-case and cross-case approaches. The interviews with adolescents were based on an innovative visual method known as ‘my story book’ which encouraged open discussion on sensitive topics.ResultsYoung women reported becoming sexually active at an early age for different reasons. Some sought a sense of intimacy, love, acceptance and belonging in these relationships, noting that they lacked this at home and/or within their peer groups. For others, their sexual activity was more functional – related to meeting survival needs. Young women reported having little control over negotiating safer sex or contraception. Their priority was preventing unwanted pregnancies yet several of the sample already had babies, and transfer to antenatal services created major disruptions in their HIV care. In contrast, caregivers and nurses regarded sexual activity from a clinical perspective, fearing onward transmission of HIV and advocating abstinence or condoms where possible. In addition, a cultural silence rooted in dominant religious and traditional norms closed down possibilities for discussion about sexual matters and prevented young women from accessing contraception.ConclusionThe study has shown how young women, caregivers and service providers have contrasting perspectives and priorities around SRH care. Illumination of these differences highlights a need for service improvement. It is suggested that young women themselves are involved in future service improvement initiatives to encourage the development of culturally and socially acceptable pathways of care.Electronic supplementary materialThe online version of this article (10.1186/s12905-017-0485-9) contains supplementary material, which is available to authorized users.

Adolescents living with HIV, complex needs and resilience in Blantyre, Malawi

“…The teen-club model as a 'one-stop shop' tries to cater to medical, social, relational, SRH and psychosocial support [25,54,70,71]. This contrasts with most studies that view provider-adolescent relationships as hindering communication about sensitive issues (mental issues, sex, pregnancy, STIs), leading to poor health outcomes [26,70]. Reflecting on how ALHIV talk and experience sex suggests changes in the experience of sex among young people, and both young men and women openly talked about love, intimacy, safer sex, contraception and marriage in the teen club in Blantyre.…”

“…The presence of trusted back-to-care tracers, coupled with a conducive environment, encouraged him to openly express his feelings. The youth wellbeing policy review for Malawi mentions that support from friends and family encourages adolescents' participation and empowerment [18,25,26]. Van Breda and Theron [36] also note that affective support from various groups of people a 'supportive social ecology' is key to successful social and health outcomes.…”

“…For Chiletso, having a child 'normalizes' sexual activities and pregnancy outcomes [26,54,68]. In addition, having a child in some African societies is seen as enhancing both male and female identities as fathers or mothers [26,69]. However, Chiletso gave birth at a very young age.…”

“…In Malawi, young people use medical and social services with mixed outcomes [18,[24][25][26][27][28]. Medical, biological and social factors influence the complexity of diseases and wellbeing over time, with interactions across these factors influencing health-seeking and outcomes [29][30][31].…”

Sexual behaviors and seroprevalence of HIV, HBV, and HCV among hill tribe youths of Northern Thailand

“…Sexual behaviors in different communities or groups of people are also dominated by their economy, culture, lifestyle, etc. [18]. Moreover, the patterns or preferences of sexual behaviors are also different from person to person and community to community, including people living in Thailand [19–21].…”