Responding to Her Question: A Review of the Influence of Pregnancy on HIV Disease Progression in the Context of Expanded Access to HAART in Sub-Saharan Africa

MacCarthy, Sarah; Laher, Fatima; Nduna, Mzikazi; Farlane, Lindiwe; Kaida, Angela

doi:10.1007/s10461-009-9541-2

Cited by 26 publications

(24 citation statements)

References 22 publications

(26 reference statements)

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“…ART also enables seropositive women to bear children with far fewer risks to themselves and their children (MacCarthy et al 2009). Accompanying this development in HIV treatment is the advent of new technologies that help serodiscordant couples conceive with minimal or no risk of infecting the HIV-negative partner: periconception ART use for the infected partner and pre-exposure prophylaxis (PrEP) for the uninfected partner combined with treatment for sexually transmitted infections; sex limited to peak fertility; and medical male circumcision and sperm washing so that the semen is removed from the sperm and the woman is artificially inseminated (either through intrauterine insemination or in vitro fertilisation) (Matthews et al 2012, Savasi et al 2013).…”

Section: Introductionmentioning

confidence: 99%

Attitudes of women and men living with HIV and their healthcare providers towards pregnancy and abortion by HIV-positive women in Nigeria and Zambia

Moore

Bankole

Awolude

et al. 2015

African Journal of AIDS Research

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Fertility decisions among people living with HIV/AIDS (PLWHA) are complicated by disease progression, the health of their existing children and possible antiretroviral therapy (ART) use, among other factors. Using a sample of HIV-positive women (n = 353) and men (n = 299) from Nigeria and Zambia and their healthcare providers (n = 179), we examined attitudes towards childbearing and abortion by HIV-positive women. To measure childbearing and abortion attitudes, we used individual indicators and a composite measure (an index). Support for an HIV-positive woman to have a child was greatest if she was nulliparous or if her desire to have a child was not conditioned on parity and lowest if she already had an HIV-positive child. Such support was found to be lower among HIV-positive women than among HIV-positive men, both of which were lower than reported support from their healthcare providers. There was wider variation in support for abortion depending on the measure than there was for support for childbearing. Half of all respondents indicated no or low support for abortion on the index measure while between 2 and 4 in 10 respondents were supportive of HIV-positive women being able to terminate a pregnancy. The overall low levels of support for abortion indicate that most respondents did not see HIV as a medical condition which justifies abortion. Respondents in Nigeria and those who live in urban areas were more likely to support HIV-positive women's childbearing. About a fifth of HIV-positive respondents reported being counselled to end childbearing after their diagnosis. In summary, respondents from both Nigeria and Zambia demonstrate tempered support of (continued) childbearing among HIV-positive women while anti-abortion attitudes remain strong. Access to ART did not impart a strong effect on these attitudes. Therefore, pronatalist attitudes remain in place in the face of HIV infection.

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Section: Introductionmentioning

confidence: 99%

Attitudes of women and men living with HIV and their healthcare providers towards pregnancy and abortion by HIV-positive women in Nigeria and Zambia

Moore

Bankole

Awolude

et al. 2015

African Journal of AIDS Research

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“…However, such research typically concentrates on pregnant women exclusively with primary outcomes that are not focused on maternal health but rather infant or child outcomes. Far less research is performed treating pregnancy either as an exposure (comparing pregnant to non-pregnant women) or as a confounder, modifier, or mediator of main effects [13]. …”

Section: Introductionmentioning

confidence: 99%

Representation of Women and Pregnant Women in HIV Research: A Limited Systematic Review

et al. 2013

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BackgroundHIV-related outcomes may be affected by biological sex and by pregnancy. Including women in general and pregnant women in particular in HIV-related research is important for generalizability of findings.ObjectiveTo characterize representation of pregnant and non-pregnant women in HIV-related research conducted in general populations.Data SourcesAll HIV-related articles published in fifteen journals from January to March of 2011. We selected the top five journals by 2010 impact factor, in internal medicine, infectious diseases, and HIV/AIDS.Study Eligibility CriteriaHIV-related studies reporting original research on questions applicable to both men and women of reproductive age were considered; studies were excluded if they did not include individual-level patient data.Study appraisal and synthesis methods.Articles were doubly reviewed and abstracted; discrepancies were resolved through consensus. We recorded proportion of female study participants, whether pregnant women were included or excluded, and other key factors.ResultsIn total, 2014 articles were published during this period. After screening, 259 articles were included as original HIV-related research reporting individual-level data; of these, 226 were determined to be articles relevant to both men and women of reproductive age. In these articles, women were adequately represented within geographic region. The vast majority of published articles, 183/226 (81%), did not mention pregnancy (or related issues); still fewer included pregnant women (n=33), reported numbers of pregnant women (n=19), or analyzed using pregnancy status (n=9).LimitationsData were missing for some key variables, including pregnancy. The time period over which published works were evaluated was relatively short.Conclusions and implications of key findings.The under-reporting and inattention to pregnancy in the HIV literature may reduce policy-makers’ ability to set evidence-based policy around HIV/AIDS care for pregnant women and women of child-bearing age.

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“…Biomedical considerations were paramount in providers’ approach to HIV infection and fertility desire; however, these considerations were often not based on accurate knowledge. Despite evidence that pregnancy does not speed progression of HIV disease [27–29], - some providers offered this as a reason for not supporting fertility desires of clients. Conception and pregnancy do confer risks of HIV transmission; however, these can be significantly reduced through specific health care interventions [20, 30].…”

Section: Discussionmentioning

confidence: 99%

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

Moodley

Cooper

Mantell

et al. 2014

BMC Health Serv Res

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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.

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Responding to Her Question: A Review of the Influence of Pregnancy on HIV Disease Progression in the Context of Expanded Access to HAART in Sub-Saharan Africa

Cited by 26 publications

References 22 publications

Attitudes of women and men living with HIV and their healthcare providers towards pregnancy and abortion by HIV-positive women in Nigeria and Zambia

Attitudes of women and men living with HIV and their healthcare providers towards pregnancy and abortion by HIV-positive women in Nigeria and Zambia

Representation of Women and Pregnant Women in HIV Research: A Limited Systematic Review

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

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