“I May Not Say We Really Have a Method, It Is Gambling Work”: Knowledge and Acceptability of Safer Conception Methods Among Providers and HIV Clients in Uganda

Abstract

In this qualitative study, researchers assessed knowledge, acceptability and feasibility of safer conception methods [SCM; timed unprotected intercourse (TUI), manual self-insemination, and sperm washing] among various healthcare providers (n=33) and 48 HIV clients with recent or current childbearing intentions in Uganda. While several clients and providers had heard of SCM, (especially TUI); few fully understood how to use the methods. All provider types expressed a desire to incorporate SCM into their practice; however, this will require training and counseling protocols, sensitization to overcome cultural norms that pose obstacles to these methods, and partner engagement (particularly men) in safer conception counseling.

Perspectives of healthcare providers and HIV-affected individuals and couples during the development of a Safer Conception Counseling Toolkit in Kenya: stigma, fears, and recommendations for the delivery of services

“…Our work in Kenya, along with similar findings from other studies, suggests that many HCPs and most HIV-affected individuals and couples are unaware of safer conception strategies that are currently available (Finocchario-Kessler et al, 2014; Matthews et al, 2014; Mmeje, Cohen, et al, 2014). HCP attitudes toward HIV-affected couples and their lack of knowledge about safer reproductive methods are barriers to the availability, provision, and uptake of safer conception services by HIV-affected couples desiring children (Breitnauer et al, 2015; Matthews et al, 2014).…”

“…Our hope is that the Toolkit will help to close the gap in clinical services that HIV-affected individuals and couples need to fulfill their reproductive goals while preventing sexual and perinatal HIV transmission in SSA (Goggin et al, 2014), where social identity and value are inextricably linked to reproduction, irrespective of HIV status (Finocchario-Kessler et al, 2014; Goggin et al, 2014; Schwartz et al, 2014). The Toolkit may help support the reproductive goals of HIV-affected individuals and couples while empowering them with knowledge to make informed reproductive health decisions.…”

“I don't know if this is right … but this is what I'm offering”: healthcare provider knowledge, practice, and attitudes towards safer conception for HIV-affected couples in the context of Southern African guidelines

“…Many couples affected by HIV now desire to have children (Beyeza-Kashesya et al, 2010; Cooper et al, 2007; Homsy et al, 2009; Nattabi, Li, Thompson, Orach, & Earnest, 2009), with studies showing that 34 to 75% of Sub-Saharan African PLWH of reproductive age consider having children (Cooper et al, 2009; Schwartz et al, 2012; Wekesa & Coast, 2014). Although provider acceptance of PLWH having children has shifted in recent years, positive attitudes towards the reproductive rights of PLWH may not in themselves result in safer conception counseling service provision (Finocchario-Kessler et al, 2014; Goggin et al, 2014). …”

A Novel Safer Conception Counseling Toolkit for the Prevention of HIV: A Mixed-Methods Evaluation in Kisumu, Kenya

“…While evidence-based guidelines for safer conception have been developed and tailored for settings in sub-Saharan Africa, including Kenya (Bekker et al, 2011; British HIV Association & Expert Advisory Group on AIDS, 2013; Loutfy et al, 2012; NASCOP, 2014; Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission, 2010; World Health Organization, 2012), HIV care providers in Kenya and throughout the region report they are not trained in safer conception methods or counseling, and HIV-affected patients are not routinely offered safer conception information or services (Crankshaw, Mindry, Munthree, Letsoalo, & Maharaj, 2014; Finocchario-Kessler et al, 2014; Goggin et al, 2014; Kawale, Mindry, Phoya, Jansen, & Hoffman, 2015; Matthews et al, 2015). Recent guidance on pre-conception care for HIV-discordant couples in Kenya outlines various safer conception strategies for HIV-discordant couples who desire children, including initiation of antiretroviral therapy at any CD4 count, viral load monitoring and suppression, limiting condomless intercourse to the ovulatory period, semen washing, and vaginal insemination timed to ovulation (NASCOP, 2014).…”