Acceptability of an Intervention to Promote Viral Suppression and Serostatus Disclosure for Men Living with HIV in South Africa: Qualitative Findings

Mathenjwa, Mxolisi; Khidir, Hazar; Milford, Cecilia; Mosery, Nzwakie; Greener, Letitia; Pratt, Madeline C; O’Neil, Kasey; Harrison, Abigail; Bangsberg, David R.; Safren, Steven A.; Smit, Jennifer; Psaros, Christina; Matthews, Lynn T.

doi:10.1007/s10461-021-03278-w

Cited by 14 publications

(14 citation statements)

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“…Another approach is to focus on male partner engagement as a way to increase SC uptake [ 87 , 88 ]. Male partners have a strong impact on fertility and SC decisions [ 18 , 24 , 25 , 31 , 33 ] and interventions that acknowledge these dynamics are needed.…”

Section: Discussionmentioning

confidence: 99%

“…Male partners likely need more information about SC methods, and identifying SC methods that men are comfortable with is critical to their use. While a study in South Africa with MLHIV who desired children found that men were enthusiastic for a clinic-based SC intervention [ 79 ], they also found structural barriers to participating in clinic-based interventions [ 87 ]. HIV-negative men in sero-different relationships may be reluctant to visit health centers for SC information and counseling.…”

Section: Discussionmentioning

confidence: 99%

“…Saleem and Pollard have suggested that having children can be a strategy that PLHIV use to conceal their status in order to avoid stigma and deal with the disruption that HIV poses to one’s reproductive identity [ 51 ]. Supporting this idea, a study from South Africa found that MLHIV see SC as an option to mitigate community-level HIV-stigma and that having children can restore their sense of value in society [ 87 ]. Using SC can therefore be seen as another coping strategy – a way to maintain one’s reproductive identity while reducing the chance of HIV transmission and the potential for stigma from one’s community.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Background A significant proportion (20-59%) of people living with HIV in sub-Saharan Africa desire childbearing, are of reproductive age, and are in sero-different relationships (~50%). Thus it is plausible that some portion of new HIV transmissions are due to attempts to become pregnant. Safer conception (SC) methods that effectively reduce the risk of HIV transmission exist and can be made available in resource-constrained settings. Few studies in the region, and none in Botswana, have quantitatively examined the correlates of information, motivation, and behavioral skills for SC uptake. Methods We surveyed 356 women living with HIV from 6/2018 to 12/2018 at six public-sector health clinics in Gaborone, Botswana. Participants were 18-40 years old, not pregnant, and desired future children or were unsure about their childbearing plans. We examined correlates of SC information, motivation, and behavioral skills using nested linear regression models, adjusting for socio-demographic, interpersonal, and structural variables. Results Knowledge of SC methods varied widely. While some SC methods were well known (medical male circumcision by 83%, antiretroviral therapy for viral suppression by 64%), most other methods were known by less than 40% of participants. Our final models reveal that stigma as well as relationship and partner factors affect SC information, motivation, and behavioral skills. Both internalized childbearing stigma (ß=-0.50, 95%CI:-0.17, -0.02) and perceived community childbearing stigma were negatively associated with SC information (ß=-0.09, 95%CI:-0.80, -0.21). Anticipated (ß=-0.06, 95%CI:-0.12, -0.003) and internalized stigma (ß=-0.27, 95%CI:-0.44; -0.10) were associated with decreased SC motivation, while perceived community childbearing stigma was associated with increased SC motivation (ß=0.07, 95%CI:0.02, 0.11). Finally, internalized childbearing stigma was associated with decreased SC behavioral skills (ß=-0.80, 95%CI: -1.12, -0.47) while SC information (ß=0.24, 95%CI:0.12, 0.36), motivation (ß=0.36, 95%CI:0.15, 0.58), and perceived partner willingness to use SC (ß=0.47, 95%CI:0.36, 0.57) were positively associated with behavioral skills Conclusions Low SC method-specific information levels are concerning since almost half (47%) of the study participants reported they were in sero-different relationships and desired more children. Findings highlight the importance of addressing HIV stigma and partner dynamics in interventions to improve SC information, motivation, and behavioral skills.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…HIV PrEP was not yet available in or recommended as part of safer conception care in South Africa at the time this study was conducted. We developed a counseling tool that integrates relevant illustrations to simplify and explain key medical concepts ( Figure 1 ) [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

“…However, the reproductive goals of people with HIV, especially men, are not discussed as part of routine clinical care. Men with HIV who want to have children feel stigmatized and are unlikely to ask providers for advice [ 16 , 17 ], and few people with HIV are aware of the opportunities to meet reproductive goals without HIV transmission [ 18 - 21 ].…”

Section: Introductionmentioning

confidence: 99%

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

Matthews¹,

Psaros²,

Mathenjwa³

et al. 2022

JMIR Form Res

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Background Many men with HIV (MWH) want to have children. HIV viral suppression minimizes sexual HIV transmission risks while allowing for conception and optimization of the health of men, their partners, and their infants. Objective This study developed and evaluated the feasibility and acceptability of an intervention to promote serostatus disclosure, antiretroviral therapy (ART) uptake and adherence, and viral suppression among MWH who want to have children in South Africa. Methods We developed a safer conception intervention (Sinikithemba Kwabesilisa or We give hope to men) to promote viral suppression via ART uptake and adherence, HIV serostatus disclosure, and other safer conception strategies for MWH in South Africa. Through 3 counseling and 2 booster sessions over 12 weeks, we offered education on safer conception strategies and aided participants in developing a safer conception plan. We recruited MWH (HIV diagnosis known for >1 month), not yet accessing ART or accessing ART for <3 months, in a stable partnership with an HIV-negative or unknown-serostatus woman, and wanting to have a child in the following year. We conducted an open pilot study to evaluate acceptability based on patient participation and exit interviews and feasibility based on recruitment and retention. In-depth exit interviews were conducted with men to explore intervention acceptability. Questionnaires collected at baseline and exit assessed disclosure outcomes; CD4 and HIV-RNA data were used to evaluate preliminary impacts on clinical outcomes of interest. Results Among 31 eligible men, 16 (52%) enrolled in the study with a median age of 29 (range 27-44) years and a median time-since-diagnosis of 7 months (range 1 month to 9 years). All identified as Black South African, with 56% (9/16) reporting secondary school completion and 44% (7/16) reporting full-time employment. Approximately 44% (7/16) of participants reported an HIV-negative (vs unknown-serostatus) partner. Approximately 88% (14/16) of men completed the 3 primary counseling sessions. In 11 exit interviews, men reported personal satisfaction with session content and structure while also suggesting that they would refer their peers to the program. They also described the perceived effectiveness of the intervention and self-efficacy to benefit. Although significance testing was not conducted, 81% (13/16) of men were taking ART at the exit, and 100% (13/13) of those on ART were virally suppressed at 12 weeks. Of the 16 men, 12 (75%) reported disclosure to pregnancy partners. Conclusions These preliminary data suggest that safer conception care is acceptable to men and has the potential to reduce HIV incidence among women and their children while supporting men’s health. Approximately half of the men who met the screening eligibility criteria were enrolled. Accordingly, refinement to optimize uptake is needed. Providing safer conception care and peer support at the community level may help reach men. Trial Registration ClinicalTrials.gov NCT03818984; https://clinicaltrials.gov/ct2/show/NCT03818984 International Registered Report Identifier (IRRID) RR2-https://doi.org/10.1007/s10461-017-1719-4

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Understanding the Stigma Experience of Men Living with HIV in Sub-Saharan Africa: A Qualitative Meta-synthesis

Janek,

Hatoum,

Ledbetter

et al. 2024

AIDS Behav

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Acceptability of an Intervention to Promote Viral Suppression and Serostatus Disclosure for Men Living with HIV in South Africa: Qualitative Findings

Cited by 14 publications

References 71 publications

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

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

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

Understanding the Stigma Experience of Men Living with HIV in Sub-Saharan Africa: A Qualitative Meta-synthesis

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