Reproductive Decision-Making and Periconception Practices Among HIV-Positive Men and Women Attending HIV Services in Durban, South Africa

Abstract

Understanding reproductive decisions and periconception behavior among HIV-discordant couples is important for designing risk reduction interventions for couples who choose to conceive. In-depth interviews were conducted to explore reproductive decision-making and periconception practices among HIV-positive women with recent pregnancy (n = 30), and HIV-positive men (n = 20), all reporting partners of negative or unknown HIV-status, and attending HIV services in Durban, South Africa. Transcripts were coded for categories and emergent themes. Participants expressed strong reasons for having children, but rarely knew how to reduce periconception HIV transmission. Pregnancy planning occurred on a spectrum ranging from explicitly intended to explicitly unintended, with many falling in between the two extremes. Male fertility desire and misunderstanding serodiscordance contributed to HIV risk behavior. Participants expressed openness to healthcare worker advice for safer conception and modified risk behavior post-conception, suggesting the feasibility of safer conception interventions which may target both men and women and include serodiscordance counseling and promotion of contraception.

Reproductive aspects and knowledge of family planning among women with Acquired Immunodeficiency Syndrome

“…In general, women with HIV/AIDS that have a steady partnership often share their reproductive decisions with their partners, which leads to an important means of social support (2) . A relationship of trust between the studied patients and their partners was confirmed by the high percentage of women that revealed their serologic status to their partners, in line with other studies (14)(15)17) . There was a link between the fact that they already had children, their age, and their educational level, RESUMO Objetivo: Analisar aspectos reprodutivos e conhecimento sobre planejamento familiar de mulheres com síndrome da imunodeficiência adquirida (Aids).…”

“…This confirms the need at the national level for diagnosis and treatment with antiretroviral drugs among pregnant women and women of reproductive age (5) , an important indicator for preventing vertical transmission of the virus. It should be mentioned that these same clinical characteristics were also found among African women (14)(15) . Considering that the discovery of infection among the current study participants took place during a prenatal examination, more than half of the women with HIV/ AIDS already had one or two children at the time of the interview, a number similar to that found in other studies (10,(13)(14) .…”

“…Considering that the discovery of infection among the current study participants took place during a prenatal examination, more than half of the women with HIV/ AIDS already had one or two children at the time of the interview, a number similar to that found in other studies (10,(13)(14) . Evidence shows that maternity is an important motivation for women with HIV/AIDS to continue with their life plans and adhere to the treatment (15) . Despite the fact that most of the women with AIDS were within reproductive age and had active sexual lives, many did not want to have children in the future, a similar finding to that of other studies (9)(10)12) .…”

“…In the current research, this aspect could be associated with the fact that women have a lower household income, already had children, or it could be related to the lack of opportunity to discuss aspects related to reproduction with health professionals. Corroborating evidence shows that the option of not having children could be related to financial difficulties, because these women already have the number of children they consider adequate, because of the stigmatization in part of family members and health professionals, as well as concerns related to their children becoming orphans, vertical transmission, and serodiscordant partners (15)(16) . Regarding family planning, most of the interviewees were not using contraceptive methods according to the standards for people with HIV/AIDS, which are the use of condoms in all sexual relations.…”

“…This study revealed that women that did not receive information on family planning are more likely to have a tubal ligation, which can be linked to their limited knowledge and myths about other contraceptive methods. Therefore, it shows the need for health professionals to offer counseling to women with AIDS regarding the options, benefits, and risks of each method to promote their autonomy during decision-making (2,15) . Steady partnership was a key factor in the desire to have children, similarly to other studies (9,25) .…”