Life projects and therapeutic itineraries: marriage, fertility, and antiretroviral therapy in Nigeria

Smith, Daniel Jordan; Mbakwem, Benjamin

doi:10.1097/01.aids.0000298101.56614.af

Cited by 81 publications

(75 citation statements)

References 14 publications

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“…Bias might have been introduced into the study by the same interviewer conducting the life history interviews in Luganda, translating and writing them up in English. HIV infected individuals whose health has been restored by ART often wish for a partner and desire for children [31][32][33][34][35] as they are reinstated into a social world that places a value on marriage and child-bearing. Among the many drivers for new relationships among people on ART is the desire for sex and children [36][37] .…”

Section: Discussionmentioning

confidence: 99%

“…Among the many drivers for new relationships among people on ART is the desire for sex and children [36][37] . All the children from Pt1's first marriage had died, yet death of children and dissolution of previous marriages are some of the factors associated with a desire for children among individuals on ART 31 . However we did not find any other study that has reported the association between the desire to have children and ART adherence.…”

Section: Discussionmentioning

confidence: 99%

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Personal barriers to antiretroviral therapy adherence: Case studies from a rural Uganda prospective clinical cohort

Mayanja¹,

Kabunga²,

Masiira³

et al. 2013

Afr H. Sci.

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Background: Although good adherence to antiretroviral therapy (ART) is essential for successful treatment outcomes, some patients may have specific personal barriers to ART adherence. Objectives: To study specific personal barriers to ART adherence. Methods: Quantitative data on patients' health status, ART adherence, CD4 cell counts and viral loads were collected, and qualitative data on life experiences of five patients with poor ART outcomes and adherence were also collected. Results: Out of 35 patients with poor immunological and virological ART outcomes, 17 (49%) also had poor ART adherence. Patient 1 had no living child and did not disclose her HIV serostatus to her spouse because she wanted to have a child. Patient 2 was an orphan with neither social nor family support. Patient 3 stopped ART when she conceived, returned to the study clinic when pregnant again and was sickly. She was switched to second-line ART with satisfactory outcomes. Patient 4, a 14 year old orphan had missed ART for 2 months when his treatment supporter was away. Patient 5 aged 66 years stopped ART which he blamed for his erectile dysfunction. Conclusions: ART adherence counselling should target specific personal barriers to ART adherence like: lack of family support, health and sexual life concerns, desire to have children and family instability.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Personal barriers to antiretroviral therapy adherence: Case studies from a rural Uganda prospective clinical cohort

Mayanja¹,

Kabunga²,

Masiira³

et al. 2013

Afr H. Sci.

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“…The questionnaire was adapted from knowledge, attitude, practice and behaviour studies in Nigeria, Uganda and South Africa. 5,[14][15][16] The questionnaire was validated in a pilot study on 10 patients attending the ART clinic at a neighbouring hospital. Minor modifications were made to the questionnaire after the pilot study.…”

Section: Methodsmentioning

confidence: 99%

Contraceptive knowledge and practice among HIV-positive women receiving antiretroviral therapy at a district hospital in KwaZulu-Natal

Somera

Ross

2013

South African Family Practice

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Objectives: To determine the knowledge and use of contraceptives by HIV-positive women attending an ART clinic.Design: Observational descriptive cross-sectional study.Setting and subjects: Many human immunodeficiency virus (HIV)-positive South African women fall pregnant each year while receiving antiretroviral therapy (ART). In 2010, 2 056 women of childbearing age attended the ART clinic at a district hospital south of Durban. Between October 2010 and June 2011, data were collected using a validated questionnaire from 400 women on their contraceptive knowledge and use. Women over 18 years of age who consented to participate, and who had been receiving ART for more than a month, were eligible for participation in the study.Outcome measures: Contraceptive knowledge and use.Results: All participants had received counselling on male condom use. The majority of HIV-positive women receiving ART preferred the male condom as their contraception of choice. Knowledge of male condoms was excellent, but only 66% of the study group used condoms, and just over 50% used a dual method of contraception (male condoms plus another contraceptive method). While 97% of participants were knowledgeable about injectable contraception, only 40% used the latter as a form of contraception. Ninety-two per cent of the participants reported recent sexual activity, 14% had fallen pregnant while receiving ART, and 64% planned on having a child in the future. Conclusion:The low use of dual contraception was a cause for concern. Recommendations include the integration of family planning services into HIV care at all ART sites. This should promote proper fertility management for women receiving ART.Peer reviewed.

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“…A literature review of factors influencing fertility desires and intentions among people living with HIV/AIDS concluded that the desire for children is associated with young age, having few children, and having access to antiretroviral therapy (ART) [20], which suggests that the variation in the observed rates of desired fertility may be attributable to differing demographics of the populations surveyed. Qualitative studies on this topic, including one performed in Kenya in 2009, revealed that the desire for children among people living with HIV is motivated by societal expectations, a strong personal wish to experience parenthood, and the belief that children signify hope and a reason for living [21][22][23]. A qualitative study of serodiscordant couples in Zambia found that the desire for children was one of the primary barriers to the use of condoms within the couple [24].…”

Section: Introductionmentioning

confidence: 99%

Pregnancy and HIV transmission among HIV-discordant couples in a clinical trial in Kisumu, Kenya

Brubaker

Odoyo

et al. 2010

HIV Medicine

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Objectives A large proportion of new HIV infections in sub‐Saharan Africa occur in stable HIV‐discordant partnerships. In some couples, the strong desire to conceive a child may lead to risky behaviour despite knowledge of discordant serostatus. Our objective was to compare HIV transmission between discordant couples who did and did not conceive during participation in a clinical trial. Methods Five hundred and thirty‐two HIV‐discordant couples were followed for up to 2 years in Kisumu, Kenya as part of the Partners in Prevention HSV/HIV Transmission Study. Quarterly HIV‐1 antibody and urine pregnancy test results were analysed. Results Forty‐one HIV‐1 seroconversions occurred over 888 person‐years of follow‐up, resulting in an annual incidence of 4.6/100 person‐years. Twenty seroconversions occurred among 186 HIV‐1‐uninfected individuals in partnerships in which pregnancy occurred (10.8% of HIV‐1‐negative partners in this group seroconverted), in comparison to 21 seroconversions among 353 uninfected individuals in partnerships in which pregnancy did not occur (5.9% of HIV‐1‐negative partners seroconverted), resulting in a relative risk of 1.8 [95% confidence interval (CI) 1.01–3.26; P<0.05]. Conclusions Pregnancy was associated with an increased risk of HIV seroconversion in discordant couples. These data suggest that the intention to conceive among HIV discordant couples may be contributing to the epidemic.

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Life projects and therapeutic itineraries: marriage, fertility, and antiretroviral therapy in Nigeria

Cited by 81 publications

References 14 publications

Personal barriers to antiretroviral therapy adherence: Case studies from a rural Uganda prospective clinical cohort

Personal barriers to antiretroviral therapy adherence: Case studies from a rural Uganda prospective clinical cohort

Contraceptive knowledge and practice among HIV-positive women receiving antiretroviral therapy at a district hospital in KwaZulu-Natal

Pregnancy and HIV transmission among HIV-discordant couples in a clinical trial in Kisumu, Kenya

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