“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 associated with 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), and the attitudes and experiences of health-care providers serving the reproductive needs of PLHIV, and client and provider views and knowledge of safer conception. This research revealed that 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Although many providers recognize the complex social realities shaping their clients' reproductive decisions, they have outdated information on serving their reproductive needs.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 toward safer conception. The adoption of a more participatory approach should be employed to equalize client–provider power dynamics and to ensure clients are more involved in decision-making about reproduction and conception.

Keywords:

• safer conception
• people living with HIV
• reproductive decision-making
• health-care providers
• South Africa

Acknowledgements

Special thanks to the participating clinics, providers, and clients who made this research possible. Thanks too to Dr. Craig Cohen, Prof. Lara Stemple, and the UCGHI Women's Health and Empowerment Center of Expertise fellows for their support and guidance in the development of this research project.

Funding

This research was supported by Award Number [R24TW008807] from the Fogarty International Center awarded through the University of California's Global Health Institute (UCGHI) and the Women's Health and Empowerment Center of Expertise. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Women's Health and Empowerment Center of Expertise, the Fogarty International Center, or the National Institutes of Health.

Additional information

Funding

Funding: This research was supported by Award Number [R24TW008807] from the Fogarty International Center awarded through the University of California's Global Health Institute (UCGHI) and the Women's Health and Empowerment Center of Expertise. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Women's Health and Empowerment Center of Expertise, the Fogarty International Center, or the National Institutes of Health.