Reproductive intentions and corresponding use of safer conception methods and contraception among Ugandan HIV clients in serodiscordant relationships

Abstract

Context Among people living with HIV in Uganda, desires to have a child and unplanned pregnancies are both common, while utilization of safer conception methods (SCM) and modern contraceptives are low. Methods Three hundred eighty-nine HIV clients who reported considering childbearing with their uninfected partner enrolled in a safer conception counseling intervention trial in Uganda. Multiple regression analysis and baseline data were used to examine correlates of reproductive intentions and behaviors, including use of safer conception methods and contraception. Results Most (n = 313; 80.5%) reported that both they and their partner wanted to have a child now, which was associated with being married, in a longer relationship, not having a child with partner, greater SCM knowledge, lower internalized childbearing stigma, and higher perceived community stigma of childbearing. However, just 117 reported trying to conceive in the prior 6 months, which was associated with being female, not having a child with their partner, less decision-making control within the relationship, and greater perceived cultural acceptability of SCM. Among those who had tried to conceive in the past 6 months, 14 (11.9%) used SCM, which was associated with greater control in decision making. Of the 268 who were not trying to conceive, 69 (25.7%) were using a modern contraceptive, which was associated with being in a shorter relationship, less control over decision-making, more positive attitudes towards contraception and lower depression. Conclusion Methods to promote reproductive goals are underused by HIV serodiscordant couples, and relationships characteristics and childbearing-related stigma appear to be most influential and thus targets for intervention. Trial registration Clinicaltrials.gov, NCT03167879; date registered May 23, 2017.

Factors associated with pregnancy uptake decisions among seropositive HIV people receiving antiretroviral therapy in sub‐Saharan Africa: A systematic review

“…Studies conducted by Okawa et al revealed that 87.4% of study participants who were adolescents living with HIV desired to have children and most of these adolescents who expressed the desire to have children opined that they felt that having children has an important meaning in their adulthood (Okawa et al, 2018 ). This was corroborated by the findings of Adeleye et al ( 2019 )), Wagner et al ( 2021 )), Toska et al ( 2020 )), Arikawa et al ( 2020 )), and Mekonnen and Enquselassie ( 2017 )); all showing that WLHIV had a good desire to have children and that will influence their decision to get pregnant.…”

“…The studies recruited participants from various backgrounds including eligible HIV‐infected women (Adeleye et al, 2019 ; Atukunda et al, 2019 ; Iliyasu et al, 2019 ; Remera et al, 2017 ), new mothers living with HIV (Cuinhane et al, 2018 ), HIV‐positive women between the ages of 15 and 44 years (Mekonnen & Enquselassie, 2017 ; Muthelo et al, 2020 ), adolescents aged 15–19 who were aware of their HIV status prior to the survey (Okawa et al, 2018 ; Toska et al, 2020 ), HIV clients in serodiscordant relationships (Nakiganda et al, 2018 ; Wagner et al, 2021 ), and also, women who were non‐pregnant, non‐menopausal, aged 18–49 and diagnosed as HIV seropositive (Arikawa et al, 2020 ). The sampling methods were systematic sampling (Adeleye et al, 2019 ; Iliyasu et al, 2019 ), non‐probability sampling technique of purposive sampling (Arikawa et al, 2020 ; Cuinhane et al, 2018 ; Mekonnen & Enquselassie, 2017 ; Muthelo et al, 2020 ), convenience sampling (Okawa et al, 2018 ), stratified sampling (Toska et al, 2020 ; Wagner et al, 2021 ), and survey (Nakiganda et al, 2018 ) while in others, eligible participants were women living with HIV (more than 18 years), admitted in a postnatal ward within 5 days postpartum regardless of pregnancy outcome (Atukunda et al, 2019 ). All the studies used primary data except two that used data collected by other institutions (Mekonnen & Enquselassie, 2017 ; Nakiganda et al, 2018 ).…”

“…One of the studies was qualitative research applying phenomenological and descriptive designs (Muthelo et al, 2020 ). The data analysis techniques employed open coding data analysis method including an inductive, descriptive coding technique (Muthelo et al, 2020 ), descriptive statistics (Adeleye et al, 2019 ; Atukunda et al, 2019 ; Wagner et al, 2021 ), chi‐square test of association (Adeleye et al, 2019 ; Okawa et al, 2018 ) and logistic regression models (binary and multiple) (Toska et al, 2020 ; Wagner et al, 2021 ) while another used qualitative approaches of thematic analysis (Cuinhane et al, 2018 ; Okawa et al, 2018 ).…”

Rural-Urban Migration, Childbearing Decision-Making, Fertility and Contraceptive Perspectives of Street Adolescents and Youth in Kampala, Uganda

“…However, irrespective of childbearing age, 94% of the street adolescents and youth expressed desire of having children in the future. In Uganda, intentions to have children are consistently high including even among people living with HIV with 88.2% wanting to have children in the future (34). However, given high youth unemployment and declining fertility rates in the country, positive fertility intentions may tend to be over-optimistic and may or may not necessarily be realised in the future (35).…”

Implementation of Comprehensive Midwifery Care

“…The government's effort to reduce maternal and neonatal mortality is through the MPS (Making Pregnancy Safer) program in which three activities in the program, namely childbirth by trained health personnel, obstetric and neonatal complications, get adequate services and access to WUS (Women of Childbearing Age) related to unprotected pregnancy. It is also undesirable to treat complications of miscarriage (Wagner, 2021).…”