Sexual and reproductive health needs of HIV-positive women in Botswana – a study of health care worker's views

Schaan, Michelle M.; Taylor, Myra; Puvimanasinghe, John P.A.; Busang, Lesego; Keapoletswe, Koona; Marlink, Richard

doi:10.1080/09540121.2012.672814

Cited by 18 publications

(15 citation statements)

References 5 publications

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“…The underlying assumption was that HIV-infected women may have worse access to or demand for contraception than HIV negative women, potentially due to barriers accessing and/or utilizing family planning services or fear of stigma from providers. [41], [42], [43] Overall, we found that approximately half of women with unintended births were actively trying to avoid pregnancy and presumably experienced contraceptive failure. Furthermore, in our adjusted model, there was no association between self-reported HIV status and contraception use, suggesting that, in Zimbabwe, the challenges to obtaining effective contraception apply equally to both HIV-uninfected and HIV-infected women, regardless of when they learned their serostatus.…”

Section: Discussionmentioning

confidence: 84%

Unmet Need for Family Planning, Contraceptive Failure, and Unintended Pregnancy among HIV-Infected and HIV-Uninfected Women in Zimbabwe

et al. 2014

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BackgroundPrevention of unintended pregnancies among women living with HIV infection is a strategy recommended by the World Health Organization for prevention of mother-to-child transmission of HIV (PMTCT). We assessed pregnancy intentions and contraceptive use among HIV-positive and HIV-negative women with a recent pregnancy in Zimbabwe.MethodsWe analyzed baseline data from the evaluation of Zimbabwe’s Accelerated National PMTCT Program. Eligible women were randomly sampled from the catchment areas of 157 health facilities offering PMTCT services in five provinces. Eligible women were ≥16 years old and mothers of infants (alive or deceased) born 9 to 18 months prior to the interview. Participants were interviewed about their HIV status, intendedness of the birth, and contraceptive use.ResultsOf 8,797 women, the mean age was 26.7 years, 92.8% were married or had a regular sexual partner, and they had an average of 2.7 lifetime births. Overall, 3,090 (35.1%) reported that their births were unintended; of these women, 1,477 (47.8%) and 1,613 (52.2%) were and were not using a contraceptive method prior to learning that they were pregnant, respectively. Twelve percent of women reported that they were HIV-positive at the time of the survey; women who reported that they were HIV-infected were significantly more likely to report that their pregnancy was unintended compared to women who reported that they were HIV-uninfected (44.9% vs. 33.8%, p<0.01). After adjustment for covariates, among women with unintended births, there was no association between self-reported HIV status and lack of contraception use prior to pregnancy.ConclusionsUnmet need for family planning and contraceptive failure contribute to unintended pregnancies among women in Zimbabwe. Both HIV-infected and HIV-uninfected women reported unintended pregnancies despite intending to avoid or delay pregnancy, highlighting the need for effective contraceptive methods that align with pregnancy intentions.

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Section: Discussionmentioning

confidence: 84%

Unmet Need for Family Planning, Contraceptive Failure, and Unintended Pregnancy among HIV-Infected and HIV-Uninfected Women in Zimbabwe

et al. 2014

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“…Patient-provider interactions, attitudes of sexual partners, and cultural norms may further influence fertility desires. Qualitative research shows that HIV positive women rarely talk to service providers about their fertility desires and providers often have negative views of pregnancy among HIV-infected individuals; therefore, women are less likely to desire a child if their service provider disapproves or stigmatizes them [12, 23-24, 30-31]. It may be important that service providers interacting with women during ART initiation or PMTCT services are trained in providing empathetic care and offering family planning counseling to all women.…”

Section: Discussionmentioning

confidence: 99%

Impact of Availability and Use of ART/PMTCT Services on Fertility Desires of Previously Pregnant Women in Rakai, Uganda

Litwin

Makumbi

Gray

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Objective To assess fertility desires by availability and use of ART/PMTCT services in Rakai, Uganda. Design Retrospective analyses of longitudinal data from the Rakai Community Cohort Study. Methods Study participants were retrospectively identified and categorized by HIV status. Availability of antiretroviral therapy and prevention of mother-to-child transmission (ART/PMTCT) services in Rakai was defined in three periods: 1) Pre-ART/PMTCT (<2005), 2) ART/PMTCT rollout (2005-06), and 3) universal ART/PMTCT (>2006); and use of ART/PMTCT was coded as yes if the woman received services. Trends in fertility desires were assessed by chi-square. “Modified” Poisson regression was performed using generalized linear models with a log link and Poisson family to estimate prevalence rate ratios (PRR) and 95% confidence intervals of desire for another child among previously and currently pregnant women; PRR were adjusted for demographic and behavioral factors. Results 4,227 sexually active women in Rakai, including 436 HIV+ women, contributed 13,970 observations over 5 survey rounds. Fertility desires increased in the population in the ART/PMTCT rollout (adjusted PRR: 1.08, CI: 1.04-1.13) and the universal availability periods (adj. PRR: 1.11, CI: 1.08-1.14) compared to pre-ART/PMTCT period. A total of 862 woman observations used ART/PMTCT services. Fertility desires were similar among ART/PMTCT service users and non-users in cross-sectional analysis (adj. PRR: 0.84, CI: 0.62-1.14) and one year after ART/PMTCT use (adj. PRR: 1.27, CI: 0.83-1.94). Conclusion Availability of ART/PMTCT may increase fertility desires of previously pregnant women in Rakai, Uganda. Use of ART/PMTCT services was not correlated with fertility desires of previously or current pregnant women.

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“…3240 Unfortunately, studies indicate that providers have not received training on how to provide safer pregnancy counselling, 40 and some have unsupportive attitudes toward fertility desires in HIV-positive patients. 151941 …”

Section: Discussionmentioning

confidence: 99%

Pregnancy desire and dual method contraceptive use among people living with HIV attending clinical care in Kenya, Namibia and Tanzania

Antelman

Medley

Mbatia³

et al. 2014

J Fam Plann Reprod Health Care

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Aim To describe factors associated with pregnancy desire and dual method use among people living with HIV in clinical care in sub-Saharan Africa. Design Sexually active HIV-positive adults were enrolled in 18 HIV clinics in Kenya, Namibia and Tanzania. Demographic, clinical and reproductive health data were captured by interview and medical record abstraction. Correlates of desiring a pregnancy within the next 6 months, and dual method use [defined as consistent condom use together with a highly effective method of contraception (hormonal, intrauterine device (IUD), permanent)], among those not desiring pregnancy, were identified using logistic regression. Results Among 3375 participants (median age 37 years, 42% male, 64% on antiretroviral treatment), 565 (17%) desired a pregnancy within the next 6 months. Of those with no short-term fertility desire (n=2542), 686 (27%) reported dual method use, 250 (10%) highly effective contraceptive use only, 1332 (52%) condom use only, and 274 (11%) no protection. Respondents were more likely to desire a pregnancy if they were from Namibia and Tanzania, male, had a primary education, were married/cohabitating, and had fewer children. Factors associated with increased likelihood of dual method use included being female, being comfortable asking a partner to use a condom, and communication with a health care provider about family planning. Participants who perceived that their partner wanted a pregnancy were less likely to report dual method use. Conclusions There was low dual method use and low use of highly effective contraception. Contraceptive protection was predominantly through condom-only use. These findings demonstrate the importance of integrating reproductive health services into routine HIV care.

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Sexual and reproductive health needs of HIV-positive women in Botswana – a study of health care worker's views

Cited by 18 publications

References 5 publications

Unmet Need for Family Planning, Contraceptive Failure, and Unintended Pregnancy among HIV-Infected and HIV-Uninfected Women in Zimbabwe

Unmet Need for Family Planning, Contraceptive Failure, and Unintended Pregnancy among HIV-Infected and HIV-Uninfected Women in Zimbabwe

Impact of Availability and Use of ART/PMTCT Services on Fertility Desires of Previously Pregnant Women in Rakai, Uganda

Pregnancy desire and dual method contraceptive use among people living with HIV attending clinical care in Kenya, Namibia and Tanzania

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