Family Planning Among HIV Positive and Negative Prevention of Mother to Child Transmission (PMTCT) Clients in a Resource Poor Setting in South Africa

Abstract

The purpose of this study was to investigate family planning needs, knowledge of HIV transmission and HIV disclosure in a cohort sample that had undergone PMTCT in a resource poor setting. Five public clinics implementing PMTCT from Qaukeni Local Service Area, O.R. Tambo District in the Eastern Cape. The sample at postnatal care consisted of 758 women with known HIV status. From 116 HIV positive women 76.3% and from 642 HIV negative women 85.2% got counseling on safe sex during pregnancy but only 65.8% and 62.3% of the women respectively practiced safe sex during pregnancy, which did not differ by HIV status. Postnatally, almost all women received counseling on family planning, yet use of contraceptives and condoms were low. Among HIV positive women PMTCT knowledge and younger age of the mother were associated with pregnancy desire, and among HIV negative women HIV disclosure to the partner, younger age of the mother and having a lower number of children were associated with pregnancy desire. High pregnancy desires (yet lower than for HIV negative women); low contraceptive and condom use were found among HIV positive women. HIV prevention and family planning must acknowledge the reproductive desires of HIV positive women and men.

Correlates of contraceptive use among HIVdiscordant couples in Kenya

“…This has been reported in a study among HIV positive and negative PMTCT clients in a South Africa where having fewer children was associated with greater pregnancy desire among the HIV negative women (Peltzer et al, 2009). Additionally, a study among HIV positive and negative women in the national PMTCT program in Rwanda found women with fewer children had a stronger desire for additional children (Hoffman et al, 2008).…”

Differences in Unintended Pregnancy, Contraceptive Use and Abortion by HIV Status Among Women in Nigeria and Zambia

“…6 The HIV epidemic is having a profound and complex effect on reproductive behavior in Africa. A desire for fewer children among HIV-positive women than among HIV-negative women or women of unknown status has been documented both in cross-sectional studies [7][8][9][10][11][12] and in longitudinal studies that followed women after they received their HIV diagnosis. [13][14][15][16] Women's decreased desire for additional children after learning they are HIVpositive has been explained by concerns over motherto-child transmission and leaving orphans, as well as by perceived health risks involved in pregnancy for an HIVpositive woman.…”

“…Although this was the case in some studies, 9,18 others found that contraceptive use was similar or lower among HIV-positive women than among their HIVnegative counterparts. 12,19 Contraceptive decisions add another dimension to reproductive choices-HIV-positive women have to navigate specific risks related to their status, such as potential interactions between contraceptives, HIV and antiretroviral drugs, or having to explain the need for contraception to a partner. 8 Considerations of abortion further complicate reproductive decisions for HIV-positive women in Africa, as they must weigh the often heavy stigma and high risk associated with a clandestine abortion against the stigma of continuing a pregnancy while HIVpositive.…”

Reproductive desires of men and women living with HIV: implications for family planning counselling

“…Various studies acknowledge the desire of PLHIV to have children (Nattabi et al, 2009). Among HIV-positive women at clinics in the Eastern Cape (South Africa) 38.8% expressed a pregnancy desire and only 65.8% reported condom use (Peltzer et al, 2009). Oladapo et al (2005) reported that in a suburban clinic in Nigeria 71.5% men and 93.3% women living with HIV wanted children.…”