"I Always Worry About What Might Happen Ahead": Implementing Safer Conception Services in the Current Environment of Reproductive Counseling for HIV-Affected Men and Women in Uganda

Overview

Journal Biomed Res Int

Publisher Wiley

Specialties Biomedical Engineering
Biotechnology
General Medicine

Date 2016 Apr 7

PMID 27051664

Citations 30

Authors

Lynn T Matthews

Francis Bajunirwe

Jasmine Kastner

Naomi Sanyu

Cecilia Akatukwasa

Courtney Ng

Rachel Rifkin

Cecilia Milford

Lizzie Moore

Ira B Wilson

David R Bangsberg

Jennifer A Smit

Angela Kaida

Affiliations

Soon will be listed here.

Abstract

Background: We explored healthcare provider perspectives and practices regarding safer conception counseling for HIV-affected clients.

Methods: We conducted semistructured interviews with 38 providers (medical and clinical officers, nurses, peer counselors, and village health workers) delivering care to HIV-infected clients across 5 healthcare centres in Mbarara District, Uganda. Interview transcripts were analyzed using content analysis.

Results: Of 38 providers, 76% were women with median age 34 years (range 24-57). First, we discuss providers' reproductive counseling practices. Emergent themes include that providers (1) assess reproductive goals of HIV-infected female clients frequently, but infrequently for male clients; (2) offer counseling focused on "family planning" and maternal and child health; (3) empathize with the importance of having children for HIV-affected clients; and (4) describe opportunities to counsel HIV-serodiscordant couples. Second, we discuss provider-level challenges that impede safer conception counseling. Emergent themes included the following: (1) providers struggle to translate reproductive rights language into individualized risk reduction given concerns about maternal health and HIV transmission and (2) providers lack safer conception training and support needed to provide counseling.

Discussion: Tailored guidelines and training are required for providers to implement safer conception counseling. Such support must respond to provider experiences with adverse HIV-related maternal and child outcomes and a national emphasis on pregnancy prevention.

Citing Articles

High PrEP uptake and objective longitudinal adherence among HIV-exposed women with personal or partner plans for pregnancy in rural Uganda: A cohort study.

Matthews L, Atukunda E, Owembabazi M, Kalyebera K, Psaros C, Chitneni P PLoS Med. 2023; 20(2):e1004088.

PMID: 36795763 PMC: 9983833. DOI: 10.1371/journal.pmed.1004088.

Demonstration and Acceptability of a Safer Conception Intervention for Men With HIV in South Africa: Pilot Cohort Study.

Matthews L, Psaros C, Mathenjwa M, Mosery N, Rambally Greener L, Khidir H JMIR Form Res. 2022; 6(5):e34262.

PMID: 35507406 PMC: 9118009. DOI: 10.2196/34262.

Relationship, partner factors and stigma are associated with safer conception information, motivation, and behavioral skills among women living with HIV in Botswana.

Gutin S, Harper G, Moshashane N, Ramontshonyana K, Stephenson R, Shade S BMC Public Health. 2021; 21(1):2231.

PMID: 34879845 PMC: 8653588. DOI: 10.1186/s12889-021-12268-5.

Implementing a Global Health Qualitative Research Study: Experiences of a Project Coordinator in Uganda.

Kastner J, Milford C, Akatukwasa C, Kembabazi A, Smit J East Afr Health Res J. 2021; 1(2):113-122.

PMID: 34308165 PMC: 8279193. DOI: 10.24248/EAHRJ-D-16-00343.

Client and Provider Experiences in Uganda Suggest Demand for and Highlight the Importance of Addressing HIV Stigma and Gender Norms Within Safer Conception Care.

Young C, Gill E, Bwana M, Muyindike W, Hock R, Pratt M AIDS Behav. 2021; 26(1):76-87.

PMID: 34152530 PMC: 8688584. DOI: 10.1007/s10461-021-03343-4.

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