Sexual and reproductive health of women living with HIV in Muslim-majority countries: a systematic mixed studies review

Abstract

Background: The number of women living with the human immunodeficiency virus (WLHIV) in Muslim-majority countries has increased significantly in the last decade. These women are often marginalized and face insecure sexual and reproductive health (SRH) needs and rights. However, little is known about the multi-faceted factors influencing these women's fertility, contraceptive, and perinatal decisions and sexual life. This systematic mixed studies review aimed to synthesize the empirical evidence on social, cultural, and structural factors influencing the SRH of WLHIV in Muslim-majority countries. Methods: This review provides a synthesis of quantitative, qualitative and mixed-method research findings searched from PubMed, EMBASE, Scopus, CINAHL and Cochrane databases. We screened 3452 SRH studies involving WLHIV. The studies, published in English between 2008 and 2017, were from 20 Muslim-majority countries with increased numbers of WLHIV. The quality of eligible studies was appraised using a mixed-methods appraisal tool (MMAT) version 2011. Findings were thematically analysed by a hybrid deductive-inductive approach. Two independent reviewers were involved in the study selection, data extraction, quality appraisal, and data synthesis. Results: We included 13 SRH-related studies involving 1748 WLHIV in eight Muslim-majority countries. Most of these studies explored fertility desire and sexual health, while only a small proportion related to contraceptive use and the perinatal-care experience. We identified that WLHIV faced neglect of their SRH rights. These rights were predominantly affected by the socio-cultural, religious and health-services context of the women's lives, which directed them to unsafe sex practices and stressful perinatal experiences. Conclusions: This study points to the need for SRH laws, policies, and interventions which stop WLHIV experiencing SRH discrimination violence and achieving their SRH rights.

Motherhood and decision-making among women living with HIV in developed countries: a systematic review with qualitative research synthesis

“…Compared to developed countries, longstanding variations in human rights, socioeconomic conditions, public policies, and health systems in developing countries differentially restrict women from accessing quality health services, achieving sexual health, and making reproductive decisions [ 28 – 31 ], especially women infected with HIV [ 32 – 42 ]. In developing countries, WLH have less favorable and more varied conditions for sexual health and reproductive services than WLH in developed countries [ 43 – 46 ] due to a complex mixture of gender and disease associated inequities related to cultural norms [ 47 ], religious doctrines [ 48 ], poverty [ 49 ], health policy [ 50 ], health services [ 51 ], and emergency conditions [ 52 ]. Developed countries provide WLH with the most supportive environments for sexual health and to engage in reproductive decision-making.…”

Inter-related Factors Influencing Sexual Quality of Life among Women Living with HIV in Banten Province, Indonesia: A Mixed Methods Study

“…32 Unsatisfactory sexual life post-HIV diagnosis has been reported in a review in Muslimmajority countries, which similarly found the reasons were related to ART event, HIV status denial, and fear of transmitting the infection. 9,15 The present study also linked the sexual dissatisfaction with women's anger and disappointment to their partner that infected them with HIV.…”

“…These gender inequalities have stopped many women, including WLHIV, in middle and low-income countries, from achieving their right to a safe and enjoyable sexual life. 15,35 The interviews suggested women diagnosed over a long time and also involved in peer support activities demonstrated and reported higher levels of SRH literacy and confidence in negotiating their needs and rights. This indicates women's ability to negotiate SRH rights tends to be developed with community peer groups' support.…”

“…[12][13][14] A systematic literature review exploring the SRH of WLHIV in Muslim-majority countries found that after diagnosis, the women experience disappointment towards their sexual life, including stressful intimacy. 15 However, there has been limited examination of Indonesian WLHIV sexual life and satisfaction. Therefore, this mixed-methods study aimed to explore the multiple factors influencing WLHIV sexual quality of life in Banten Province, Indonesia.…”

Exploring perceived effects from loss of PEPFAR support for outreach in Kenya and Uganda

“…The region is remote, with low population density, and has faced challenges with instability and terrorism [24]. Religious differences with the rest of the country may also influence attitudes and stigma towards HIV/AIDS [25]. The region has also experienced increasing infrastructure development over the past decade, including road construction, a new airport, and a new port, raising potential for evolving patterns of disease transmission as migration patterns change [26][27][28].…”