Health care provider perspectives on pregnancy and parenting in HIV-positive individuals in South Africa

Abstract

BackgroundWithin the health system, limited attention is given to supporting the fertility and parenting desires on HIV-positive people. In this study, we explore health care providers’ knowledge and perspectives on safer conception and alternate parenting strategies for HIV-positive people.MethodsBetween November 2007 and January 2008, in-depth interviews were conducted with 28 health care workers involved in providing HIV and/or antiretroviral services at public sector clinics in Cape Town, South Africa. Views on sexual and reproductive health services, pregnancy, childbearing and parenting in HIV-positive men and women were explored using a semi-structured interview guide. Data were analyzed using a thematic approach.ResultsProviders recognized the sexual and reproductive rights of HIV-positive individuals, but struggled with the tension between supporting these rights and concerns about spreading infection. Limited knowledge of safer conception methods constrained their ability to counsel and support clients in realizing fertility desires. Providers believed that parenting alternatives that do not maintain biological and cultural linkage are unlikely to be acceptable options.ConclusionsHealth care provider training and support is critical to providing comprehensive sexual and reproductive health care and meeting the fertility desires of HIV-positive people.

Supporting HIV prevention and reproductive goals in an HIV-endemic setting: taking safer conception services from policy to practice in South Africa

“…Earlier research suggested that providers tended to focus on negative outcomes of childbearing for PLHIV, creating reluctance to advise condomless sex or other safer conception methods for PLHIV and their partners [6,42–44]. However, recent studies indicate that providers increasingly empathize with reproductive goals of PLHIV, recognize reduced perinatal transmissions following eMTCT interventions, acknowledge the need for safer conception training and care and show greater awareness of safer conception methods [45–50]. In order to cement this shift, widespread promotion of a reproductive-rights based patient care approach is required.…”

Sexual and reproductive health needs of HIV-positive people in Tehran, Iran: a mixed-method descriptive study

“…Couples who are living with HIV and do not desire to get pregnant and want to use a permanent method of family planning must be able to easily access tubal ligation and vasectomy methods; they should be trained and advised about using these methods but they must not be forced to use one of these methods. Healthcare providers' training, as well as systematizing the assessment of reproduction intention of PLHIV seem necessary to meet the sexual and reproductive health needs of this sub population in the communities (31). They also should consider that the contraceptive methods should be acceptable by PLHIV.…”

An Approach to Developing a Prediction Model of Fertility Intent Among HIV-Positive Women and Men in Cape Town, South Africa: A Case Study

“…Numerous studies have shown that health care providers often refrain from asking HIV-positive individuals, especially men, about their fertility desires [61]. Among many clinicians there is low awareness of safer conception options and that HIV serodiscordance can be maintained in a couple [61].…”

“…Numerous studies have shown that health care providers often refrain from asking HIV-positive individuals, especially men, about their fertility desires [61]. Among many clinicians there is low awareness of safer conception options and that HIV serodiscordance can be maintained in a couple [61]. There is also a perception that in the pre-ART period couples do not consider fertility issues [61], despite the fact that fertility planning is critical in this group.…”

“…Among many clinicians there is low awareness of safer conception options and that HIV serodiscordance can be maintained in a couple [61]. There is also a perception that in the pre-ART period couples do not consider fertility issues [61], despite the fact that fertility planning is critical in this group. Use of a brief screening tool consisting of variables identified in a prediction model can serve to jumpstart health care providers’ discussion of fertility intent with HIV-positive individuals, prepare providers to develop a plan with their patients, and guide patients to make informed decisions about both contraception and safer conception options in a non-judgmental manner [62].…”