“We have to try and have this child before it is too late”: missed opportunities in client–provider communication on reproductive intentions of people living with HIV

Abstract

Men and women living with HIV with access to ARVs are living longer, healthier lives that can and often do include bearing children. Children occupy a key space in men and women's personal and social lives and often play a fundamental role in maintaining these relationships, irrespective of illness concerns. Couples living with HIV need to balance prevention needs and ill health while trying to maintain healthy relationships. Health care providers serving the reproductive needs of HIV-affected couples need to consider the social and relational factors shaping reproductive decisions and associated periconception risk behaviors. This paper based on qualitative research at three hospital sites in eThekwini District, South Africa, investigates the childbearing intentions and needs of people living with HIV (PLHIV), attitudes and experiences of healthcare providers serving the reproductive needs of PLHIV, and client and provider views and knowledge of safer conception. This research revealed personal, social, and relationship dynamics shape the reproductive decisions of PLHIV and "unplanned" pregnancies are not always unintended. Additionally, conception desires are not driven by the number of living children, rather clients are motivated by whether or not they have had any children with their current partner/spouse. Providers should consider the relationship status of clients in discussions about childbearing desires and intentions. Although many providers recognize the complex social realities shaping NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript their clients' reproductive decisions, they have outdated information on serving their reproductive needs. Appropriate training to enable providers to better understand the relationship and social realities surrounding their clients' childbearing intentions is required and should be used as a platform for couples to work together with providers towards safer conception. The adoption of a more participatory approach should be employed to equalize client-provider power dynamics and ensure clients are more involved in decision-making about reproduction and conception.

Client and provider knowledge and views on safer conception for people living with HIV (PLHIV)

“…These findings are comparable to those of Finocchario-Kessler et al (2014) in Uganda [7]. Providers also need values clarification training to help them separate their personal beliefs and clients’ rights to have children [30]. South Africa’s clinical guidelines for delivery of safer conception services need to be reviewed and adapted for use within the National Department of Health.…”

“…Although client interviews reflected a strong need for SC counseling, provider interviews revealed their hesitancy toward providing such services given their limited knowledge, a lack of Department of Health guidelines and training, concerns about client treatment adherence, and providers’ personal beliefs [23,29,30]. Providers expressed concerns about preconception counseling and encouraging PLHIV to have children while a few noted that some providers are uncomfortable discussing sexual matters with clients.…”

A Systematic Review of the Current Status of Safer Conception Strategies for HIV Affected Heterosexual Couples in Sub-Saharan Africa

“…Many studies identified provider level barriers to SCS acceptability including providers being indifferent or opposed to people living with HIV having children [22, 39, 47, 51–53] or providers expressing discomfort discussing sex, especially condomless sex in patients living with HIV, thus limiting SCS discussions [20, 50, 51]. As a result, some providers did not recommend child-bearing for people living with HIV or serodiscordant couples due to secondary transmission concerns [22, 65].…”

Fertility Decision-Making Among Kenyan HIV-Serodiscordant Couples Who Recently Conceived: Implications for Safer Conception Planning

“…44,45 Other studies have reported that although HIVserodiscordant couples desired children, conception was rarely planned and advice was only sought after pregnancy. 46 Discussion of safer conception strategies with providers early in HIV care with male participation may reduce potential HIV transmission risk from these missed opportunities. 17 Couples with HIV-infected men need to be counseled on safer conception strategies that support fertility goals of both partners while minimizing HIV risk to the woman.…”