Abstract
BackgroundWithin the health system, limited attention is given to supporting the fertility and parenting desires on HIV-positive people. In this study, we explore health care providers’ knowledge and perspectives on safer conception and alternate parenting strategies for HIV-positive people.MethodsBetween November 2007 and January 2008, in-depth interviews were conducted with 28 health care workers involved in providing HIV and/or antiretroviral services at public sector clinics in Cape Town, South Africa. Views on sexual and reproductive health services, pregnancy, childbearing and parenting in HIV-positive men and women were explored using a semi-structured interview guide. Data were analyzed using a thematic approach.ResultsProviders recognized the sexual and reproductive rights of HIV-positive individuals, but struggled with the tension between supporting these rights and concerns about spreading infection. Limited knowledge of safer conception methods constrained their ability to counsel and support clients in realizing fertility desires. Providers believed that parenting alternatives that do not maintain biological and cultural linkage are unlikely to be acceptable options.ConclusionsHealth care provider training and support is critical to providing comprehensive sexual and reproductive health care and meeting the fertility desires of HIV-positive people.
Highlights
Within the health system, limited attention is given to supporting the fertility and parenting desires on HIV-positive people
In recent years, HIVrelated mortality and morbidity have declined, the quality of life has greatly improved, HIV is viewed as a chronic condition, and the vast majority of people living with HIV are of childbearing age. This combination of factors has contributed to a greater awareness of the sexual and reproductive health (SRH) needs of HIV-positive individuals; attention to their safer conception needs, i.e., reducing infection risk while trying to conceive and
Services provided at the clinics include general HIV care services and CD4 monitoring; antiretroviral therapy (ART); SRH services such as family planning, antenatal and post-natal health care, maternity services, termination of pregnancy counseling, sexually transmitted disease care and cervical cancer screening; treatment of communicable diseases such as tuberculosis; child care services; treatment of minor ailments; and treatment of chronic diseases
Summary
Within the health system, limited attention is given to supporting the fertility and parenting desires on HIV-positive people. In recent years, HIVrelated mortality and morbidity have declined, the quality of life has greatly improved, HIV is viewed as a chronic condition, and the vast majority of people living with HIV are of childbearing age This combination of factors has contributed to a greater awareness of the sexual and reproductive health (SRH) needs of HIV-positive individuals; attention to their safer conception needs, i.e., reducing infection risk while trying to conceive and Fertility in Africa is highly prized, with strong societal pressures to have children, the need to have boys as heirs, and preference for large families [3,4,5]. Technology-intensive safer conception options such as intrauterine insemination and intracytoplasmic sperm injection are beyond the resource capacity of most developing countries, strategies, such as assisted manual self-insemination, sperm washing, and timed intercourse, are less technology-intensive and could play a role in reducing HIV risk for infected individuals in resourceconstrained settings such as South Africa
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