Skip to main content

Advertisement

SpringerLink
Log in

Discussing Reproductive Plans with Healthcare Providers by Sexually Active Women Living with HIV in Western Ethiopia

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Discussing reproductive plans with healthcare providers by women living with HIV (WLHIV) can assist in promoting safe reproductive health practices, but little research has been undertaken in this area. A cross-sectional survey was conducted in western Ethiopia in 2018 among 475 sexually active WLHIV. One hundred and twenty seven (26.8%) participants reported becoming pregnant in the last 5 years after being aware of their HIV-positive status; 33.6% reported their intention to have children in the future, and 26.9% were ambivalent about having children. WLHIV who reported general and personalized discussions of reproductive plans with healthcare providers were 30.7% and 16.8%, respectively. Unmarried sexually active women and WLHIV accessing health centers for antiretroviral therapy (ART) were less likely to report both general and personalized discussions than married women and women who accessed ART through hospitals, respectively. WLHIV are both having and intending to have children, highlighting discussions with healthcare providers can deliver support that reduces the risk of vertical and horizontal HIV transmission.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

AOR:

Adjusted odds ratio

ART:

Antiretroviral therapy

CI:

Confidence interval

HREC:

Human Research Ethics Committee

HIV:

Human immunodeficiency virus

Km:

Kilometre

WLHIV:

Women living with HIV

References

  1. Floyd S, Marston M, Baisley K, Wringe A, Herbst K, Chihana M, Kasamba I, Bärnighausen T, Urassa M, French N. The effect of antiretroviral therapy provision on all-cause, AIDS and non-AIDS mortality at the population level—a comparative analysis of data from four settings in Southern and East Africa. Tropical Med Int Health. 2012;17(8):e84–e93.

    Google Scholar 

  2. World Health Organization. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva: WHO; 2015.

    Google Scholar 

  3. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, Hakim JG, Kumwenda J, Grinsztejn B, Pilotto JH, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Loutfy M, Khosla R, Narasimhan M. Advancing the sexual and reproductive health and human rights of women living with HIV. J Int AIDS Soc. 2015;18(Suppl 5):20760.

    PubMed  PubMed Central  Google Scholar 

  5. Marston M, Nakiyingi-Miiro J, Hosegood V, Lutalo T, Mtenga B, Zaba B, ALPHA Network. Measuring the impact of antiretroviral therapy roll-out on population level fertility in three African countries. PLoS ONE. 2016;11(3):e0151877.

    PubMed  PubMed Central  Google Scholar 

  6. Nattabi B, Li J, Thompson SC, Orach CG, Earnest J. A systematic review of factors influencing fertility desires and intentions among people living with HIV/AIDS: implications for policy and service delivery. AIDS Behav. 2009;13(5):949–68.

    PubMed  Google Scholar 

  7. Stewart ZA, Shipley K, Spelman T, Giles ML. Factors associated with discussion of sexual activity and contraception in women with HIV. J Fam Plann Reprod Health Care. 2016;42(1):12–6.

    PubMed  Google Scholar 

  8. UNAIDS. Ethiopian progress report. UNAIDS, 2014.

  9. Smith DM, Wong JK, Hightower GK, Ignacio CC, Koelsch KK, Daar ES, Richman DD, Little SJ. Incidence of HIV superinfection following primary infection. JAMA. 2004;292(10):1177–8.

    CAS  PubMed  Google Scholar 

  10. Finocchario-Kessler S, Dariotis JK, Sweat MD, Trent ME, Keller JM, Hafeez Q, Anderson JR. Do HIV-infected women want to discuss reproductive plans with providers, and are those conversations occurring? AIDS Patient Care STDs. 2010;24(5):317–23.

    PubMed  PubMed Central  Google Scholar 

  11. Aaron EZ, Criniti SM. Preconception health care for HIV-infected women. Top HIV Med. 2007;15(4):137–41.

    PubMed  Google Scholar 

  12. Wagner G, Linnemayr S, Kityo C, Mugyenyi P. Factors associated with intention to conceive and its communication to providers among HIV clients in Uganda. Matern Child Health J. 2012;16(2):510–8.

    PubMed  Google Scholar 

  13. Huynh L, Gysler M, Loutfy MR, Margolese S, Yudin MH, Conway T, Maxwell J, Muchenje M, O'Brien-Teengs D, Shapiro H. Access to conception planning information and services for people living with HIV in Ontario, Canada: a community-based research study. Vulnerable Child Youth Stud. 2012;7(1):6–19.

    Google Scholar 

  14. Crankshaw TL, Matthews LT, Giddy J, Kaida A, Ware NC, Smit JA, Bangsberg DR. A conceptual framework for understanding HIV risk behavior in the context of supporting fertility goals among HIV-serodiscordant couples. Reprod Health Matters. 2012;20(39 Suppl):50–60.

    PubMed  PubMed Central  Google Scholar 

  15. Johnson FA, Frempong-Ainguah F, Matthews Z, Harfoot AJ, Nyarko P, Baschieri A, Gething PW, Falkingham J, Atkinson PM. Evaluating the impact of the community-based health planning and services initiative on uptake of skilled birth care in Ghana. PLoS ONE. 2015;10(3):e0120556.

    PubMed  PubMed Central  Google Scholar 

  16. Homsy J, Bunnell R, Moore D, King R, Malamba S, Nakityo R, Glidden D, Tappero J, Mermin J. Reproductive intentions and outcomes among women on antiretroviral therapy in rural Uganda: a prospective cohort study. PLoS ONE. 2009;4(1):e4149.

    PubMed  PubMed Central  Google Scholar 

  17. Mindry DL, Crankshaw TL, Maharaj P, Munthree C, Letsoalo T, Milford C, Greener RM, Rambally L, Carpenter S, Smit JA. "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. AIDS Care. 2015;27(1):25–30.

    CAS  PubMed  Google Scholar 

  18. Yeatman SE. The impact of HIV status and perceived status on fertility desires in rural Malawi. AIDS Behav. 2009;13(Suppl 1):12–9.

    PubMed  Google Scholar 

  19. Schwartz SR, Mehta SH, Taha TE, Rees HV, Venter F, Black V. High pregnancy intentions and missed opportunities for patient-provider communication about fertility in a South African cohort of HIV-positive women on antiretroviral therapy. AIDS Behav. 2012;16(1):69–78.

    PubMed  Google Scholar 

  20. Hayford SR, Agadjanian V. Providers' views concerning family planning service delivery to HIV-positive women in Mozambique. Stud Fam Plann. 2010;41(4):291–300.

    PubMed  PubMed Central  Google Scholar 

  21. Finocchario-Kessler S, Bastos FI, Malta M, Anderson J, Goggin K, Sweat M, Dariotis J, Bertoni N, Kerrigan D, Rio Collaborative G. Discussing childbearing with HIV-infected women of reproductive age in clinical care: a comparison of Brazil and the US. AIDS Behav. 2012;16(1):99–107.

    PubMed  Google Scholar 

  22. Feyissa GT, Lockwood C, Woldie M, Munn Z. Reducing HIV-related stigma and discrimination in healthcare settings: a systematic review of quantitative evidence. PLoS ONE. 2019;14(1):e0211298.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36:1–10.

    CAS  PubMed  Google Scholar 

  24. Babitsch B, Gohl D, Von Lengerke T. Re-revisiting Andersen’s Behavioral Model of Health Services Use: a systematic review of studies from 1998–2011. GMS Psycho-Social-Medicine. 2012. https://doi.org/10.3205/psm000089.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Tesfaye G, Chojenta C, Smith R, Loxton D. Application of the Andersen-Newman model of health care utilization to understand antenatal care use in Kersa District, Eastern Ethiopia. PLoS ONE. 2018. https://doi.org/10.1371/journal.pone.0208729.

    Article  PubMed  PubMed Central  Google Scholar 

  26. MacCarthy S, Rasanathan JJ, Ferguson L, Gruskin S. The pregnancy decisions of HIV-positive women: the state of knowledge and way forward. Reprod Health Matters. 2012;20(39 Suppl):119–40.

    PubMed  Google Scholar 

  27. WHO. Medical eligibility criteria for contraceptive use. 5th ed. Geneva: WHO; 2015.

    Google Scholar 

  28. Kesetebirhan, A. National guideline for family planning services in Ethiopia. Federal Democratic Republic of Ethiopia, Ministry of Health 2011.

  29. CSA. Population projection of ethiopia for all regions at wereda level from 2014–2017. Addis Ababa: Central Statistical Agency; 2013.

    Google Scholar 

  30. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.

    PubMed  Google Scholar 

  31. CSACE I. Ethiopia demographic and health survey 2016. Addis Ababa: CSA and ICF; 2016.

    Google Scholar 

  32. Finocchario-Kessler S, Sweat MD, Dariotis JK, Trent ME, Kerrigan DL, Keller JM, Anderson JR. Understanding high fertility desires and intentions among a sample of urban women living with HIV in the United States. AIDS Behav. 2010;14(5):1106–14.

    PubMed  Google Scholar 

  33. Loutfy MR, Blitz S, Zhang Y, Hart TA, Walmsley SL, Smaill FM, Rachlis AR, Yudin MH, Angel JB, Ralph ED, et al. Self-reported preconception care of HIV-positive women of reproductive potential: a retrospective study. J Int Assoc Provid AIDS Care. 2014;13(5):424–33.

    PubMed  Google Scholar 

  34. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.

    PubMed  Google Scholar 

  35. Li Y-N, Nong D-X, Wei B, Feng Q-M, Luo H-Y. The impact of predisposing, enabling, and need factors in utilization of health services among rural residents in Guangxi, China. BMC Health Serv Res. 2016;16(1):592.

    PubMed  PubMed Central  Google Scholar 

  36. Munyazesa E, Emile I, Mutimura E, Hoover DR, Shi Q, McGinn AP, Musiime S, Muhairwe F, Rutagengwa A, Dusingize JC. Assessment of haematological parameters in HIV-infected and uninfected Rwandan women: a cross-sectional study. BMJ Open. 2012;2(6):e001600.

    PubMed  PubMed Central  Google Scholar 

  37. Matthews LT, Beyeza-Kashesya J, Cooke I, Davies N, Heffron R, Kaida A, Kinuthia J, Mmeje O, Semprini AE, Weber S. Consensus statement: supporting safer conception and pregnancy for men and women living with and affected by HIV. AIDS Behav. 2018;22(6):1713–24.

    PubMed  Google Scholar 

  38. Matthews LT, Mukherjee JS. Strategies for harm reduction among HIV-affected couples who want to conceive. AIDS Behav. 2009;13(Suppl 1):5–11.

    PubMed  Google Scholar 

  39. Heffron R, Thomson K, Celum C, Haberer J, Ngure K, Mugo N, Bukusi E, Katabira E, Odoyo J, Bulya N. Fertility intentions, pregnancy, and use of PrEP and ART for safer conception among East African HIV serodiscordant couples. AIDS Behav. 2018;22(6):1758–65.

    PubMed  PubMed Central  Google Scholar 

  40. Pinsky AN, Steenbergh K, Boyd HM, Michael B, Bekele D, Kobernik E, Gebremedhin LT, Mmeje O. Healthcare provider attitudes regarding the provision of assisted reproductive services for HIV-affected couples in Addis Ababa, Ethiopia. Int J Gynecol Obstet. 2018;141(1):45–51.

    Google Scholar 

  41. Matthews LT, Crankshaw T, Giddy J, Kaida A, Psaros C, Ware NC, Smit J, Bangsberg DR. Reproductive counseling by clinic healthcare workers in Durban, South Africa: perspectives from HIV-infected men and women reporting serodiscordant partners. Infect Dis Obstet Gynecol. 2012. https://doi.org/10.1155/2012/146348.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Davies N, Ashford G, Bekker LG, Chandiwana N, Cooper D, Dyer SJ, Jankelowitz L, Mhlongo O, Mnyani CN, Mulaudzi MB, et al. Guidelines to support HIV-affected individuals and couples to achieve pregnancy safely: update 2018. S Afr J HIV Med. 2018;19(1):915.

    Google Scholar 

  43. Hoffman RM, Jaycocks A, Vardavas R, Wagner G, Lake JE, Mindry D, Currier JS, Landovitz RJ. Benefits of PrEP as an adjunctive method of HIV prevention during attempted conception between HIV-uninfected women and HIV-infected male partners. J Infect Dis. 2015;212(10):1534–43.

    PubMed  PubMed Central  Google Scholar 

  44. Wagner GJ, Goggin K, Mindry D, Beyeza-Kashesya J, Finocchario-Kessler S, Woldetsadik MA, Khanakwa S, Wanyenze RK. Correlates of use of timed unprotected intercourse to reduce horizontal transmission among Ugandan HIV clients with fertility intentions. AIDS Behav. 2015;19(6):1078–88.

    PubMed  PubMed Central  Google Scholar 

  45. Finocchario-Kessler S, Wanyenze R, Mindry D, Beyeza-Kashesya J, Goggin K, Nabiryo C, Wagner G. "I may not say we really have a method, it is gambling work": knowledge and acceptability of safer conception methods among providers and HIV clients in Uganda. Health Care Women Int. 2014;35(7–9):896–917.

    PubMed  PubMed Central  Google Scholar 

  46. Kumar S, Gruskin S, Khosla R, Narasimhan M. Human rights and the sexual and reproductive health of women living with HIV—a literature review. J Int AIDS Soc. 2015;18:20290.

    PubMed  PubMed Central  Google Scholar 

  47. Mmeje O, Njoroge B, Akama E, Leddy A, Breitnauer B, Darbes L, Brown J. Perspectives of healthcare providers and HIV-affected individuals and couples during the development of a Safer Conception Counseling Toolkit in Kenya: stigma, fears, and recommendations for the delivery of services. AIDS Care. 2016;28(6):750–7.

    PubMed  PubMed Central  Google Scholar 

  48. Mutemwa R, Mayhew SH, Warren CE, Abuya T, Ndwiga C, Kivunaga J. Does service integration improve technical quality of care in low-resource settings? An evaluation of a model integrating HIV care into family planning services in Kenya. Health Policy Plann. 2017;32(suppl_4):iv91–iv101.

    Google Scholar 

  49. Matthews LT, Smit JA, Cu-Uvin S, Cohan D. Antiretrovirals and safer conception for HIV-serodiscordant couples. Curr Opin HIV AIDS. 2012;7(6):569.

    CAS  PubMed  PubMed Central  Google Scholar 

  50. Hoffman IF, Martinson FE, Powers KA, Chilongozi DA, Msiska ED, Kachipapa EI, Mphande CD, Hosseinipour MC, Chanza HC, Stephenson R. The year-long effect of HIV-positive test results on pregnancy intentions, contraceptive use, and pregnancy incidence among Malawian women. JAIDS J Acquir Immune Defic Syndr. 2008;47(4):477–83.

    PubMed  Google Scholar 

  51. Hargrove JW, Humphrey JH, Group ZS. Mortality among HIV-positive postpartum women with high CD4 cell counts in Zimbabwe. Aids. 2010;24(3):F11–F14.

    PubMed  Google Scholar 

  52. Kuhn L, Sinkala M, Kankasa C, Semrau K, Kasonde P, Scott N, Mwiya M, Vwalika C, Walter J, Tsai WY, et al. High uptake of exclusive breastfeeding and reduced early post-natal HIV transmission. PLoS ONE. 2007;2(12):e1363.

    PubMed  PubMed Central  Google Scholar 

  53. Haberer JE, Bwana BM, Orrell C, Asiimwe S, Amanyire G, Musinguzi N, Siedner MJ, Matthews LT, Tsai AC, Katz IT. ART adherence and viral suppression are high among most non-pregnant individuals with early-stage, asymptomatic HIV infection: an observational study from Uganda and South Africa. J Int AIDS Soc. 2019;22(2):e25232.

    PubMed  PubMed Central  Google Scholar 

  54. Matthews LT, Milford C, Kaida A, Ehrlich MJ, Ng C, Greener R, Mosery F, Harrison A, Psaros C, Safren SA. Lost opportunities to reduce periconception HIV transmission: safer conception counseling by South African providers addresses perinatal but not sexual HIV transmission. J Acquir Immune Defic Syndr. 2014;67(Suppl 4):S210.

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We would like to thank study participants and data collectors for making this research successful. We are grateful to the Hunter Medical Research Institute/Greaves Family Postgraduate Top-Up Scholarship. TRF is supported by The University of Newcastle International Postgraduate Research Scholarship (UNIPRS) and The University of Newcastle Research Scholarship Central 50:50 (UNRSC 50:50). Dr Melissa Harris is supported by an Australian Research Council Discovery Early Career Researcher Award (DECRA). We would also like to thank Natalia Soeters for language edition.

Funding

This study was funded by the Hunter Medical Research Institute/Greaves Family Postgraduate Top-Up Scholarship (Grant Number G1701582).

Author information

Authors and Affiliations

  1. College of Health Science, Wollega University, Nekemte, Oromia, Ethiopia

    Tesfaye Regassa Feyissa

  2. Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia

    Tesfaye Regassa Feyissa, Melissa L. Harris & Deborah Loxton

Authors
  1. Tesfaye Regassa Feyissa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Melissa L. Harris
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Deborah Loxton
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

TRF, MLH, and DL contributed to the conception and design of the study. Involved in the conduct of the study: TRF, MLH, and DL. Contributed to analysis and interpretation of the data: TRF, MLH, and DL. Involved in drafting the manuscript and revising it critically: TRF, MLH, and DL. All authors have given final approval for the manuscript to be published.

Corresponding author

Correspondence to Tesfaye Regassa Feyissa.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethical Approval

The Human Research Ethics Committee (HREC) of The University of Newcastle, Australia (H-2017-0289), and the Oromia Regional State Health Bureau Research Ethics Committee, Ethiopia (BEFO/HBISH/1-16/257) approved this study. All participants provided informed consent prior to survey administration.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Feyissa, T.R., Harris, M.L. & Loxton, D. Discussing Reproductive Plans with Healthcare Providers by Sexually Active Women Living with HIV in Western Ethiopia. AIDS Behav 24, 2842–2855 (2020). https://doi.org/10.1007/s10461-020-02833-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-020-02833-1

Keywords

Search

Navigation