“What if They Are Pre-conception? What Should We Do?”: Knowledge, Practices, and Preferences for Safer Conception Among Women Living With HIV and Healthcare Providers in Gaborone, Botswana

Abstract

Safer conception interventions that address HIV care, treatment, and prevention for HIV-affected couples are increasingly available in sub-Saharan Africa. Botswana, an HIV endemic country, is yet to offer formal safer conception services although universal test-and-treat approaches mean that increasing numbers of young, sexually active people living with HIV will start treatment and likely desire childbearing. In order to advance the safer conception discussion in Botswana, it is necessary to understand the current safer conception knowledge, practices, and preferences of healthcare providers and women living with HIV (WLHIV). We conducted qualitative in-depth interviews with 10 HIV healthcare providers and 10 WLHIV in Gaborone. Interviews were analyzed using a phenomenological approach. Safer conception knowledge was limited and safer conception discussions were rare. Healthcare provider and WLHIV preferences were at odds, with providers preferring WLHIV to initiate safer conception discussions, and WLHIV desiring providers to initiate safer conception discussions. Quotes from women and providers highlight deeper issues about power dynamics, concerns about stigma among women, and provider fears about promoting pregnancy. Providers emphasized the need for guidelines and training in order to improve the provision of safer conception counseling. These findings point to areas where safer conception in Botswana can be improved. Both WLHIV and providers would benefit from having information about a range of safer conception methods and approaches. In addition, since WLHIV felt hesitant about initiating safer conception conversations and feared stigma, and because putting the onus for starting safer conception discussions on women is a reversal of normal roles and power structures, providers must take the lead and routinely initiate fertility desire and safer conception discussions. Assisting healthcare providers with clear safer conception guidelines and training would improve the provision of accurate safer conception counseling and facilitate reproductive choice.

One in Five Street Traditional Coffee Vendors Suffered from Depression During the COVID-19 Pandemic in Harar Town, Ethiopia

“…34,35 Women, in particular, are at increased risk of mental disorders probably due to the lack of social support, high workload/family burden, and poor recognition. 36,37 In COVID-19 affected areas, women were found to be economically disadvantaged. 38 In developing countries, women are usually prevented from entering formal sectors in relation to culture, religion, illiteracy, and family obligations.…”

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

“…Similarly, a South African study among MLHIV who desired children found that men wanted to avoid using ART as treatment as prevention [ 79 ]. Clients would benefit from having information about a wide range of SC methods since one approach will not work for all couples and providing options supports reproductive choice [ 22 , 66 , 79 ]. Therefore, an intervention aimed at improving SC uptake would need to educate PLHIV about a range of SC techniques.…”

“…In addition, anticipated HIV stigma from family members and healthcare providers had a negative impact on motivation to use SC. In our prior qualitative work in Botswana, we found that WLHIV anticipated stigma from healthcare providers and were afraid to discuss their fertility desires with them [ 38 , 66 ]. Qualitative studies from Uganda and South Africa have similarly found that anticipated stigma is a barrier to seeking SC services [ 85 , 93 ] and that MLHIV feel they cannot discuss SC with healthcare providers [ 79 ].…”

“…Response options were on a 4-point scale from 1 (I cannot do this at all) to 4 (I can definitely do this) (see Additional file 1 for full scale). An example question was: “How certain are you that you and your current partner could talk about ways to make conception safer if you ever wanted to become pregnant in the future?” Items for this scale were developed based on prior literature and our own qualitative research in Botswana which found that communication skills with providers [ 35 , 47 , 66 ] and partners [ 34 , 67 , 68 ] were particularly salient behavioral skills for SC. Content validity was assessed by submitting items to content experts (two experts in the field of sexual and reproductive health (SRH)/SC (one doctor from Botswana, one researcher from the USA) and two local Botswana researchers with many years of experience in SRH/HIV research in Botswana) for review during survey development.…”

Global research priorities for COVID-19 in maternal, reproductive and child health: Results of an international survey

“…While COVID-19 has been seen to directly impact the health of pregnant women and their infants, it is also important that we understand the effect that the behavioral and societal responses to the pandemic have had on this cohort. A notable rise in sexual and gender based violence has been documented in many global regions during the pandemic, and while research has identified higher rates of self-reported depression and anxiety among pregnant and postpartum women, a reduction in mental health and support services has also been noted in many parts of the world [42][43][44][45]. In light of this, we must also seek to better understand the full extent of the challenges these women face in order to design more robust support measures for them as the pandemic persists.…”