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Client and Provider Experiences in Uganda Suggest Demand for and Highlight the Importance of Addressing HIV Stigma and Gender Norms Within Safer Conception Care

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Abstract

Safer conception counseling supports HIV-serodifferent couples to meet reproductive goals while minimizing HIV transmission risk, but has not been integrated into routine HIV care. We piloted a novel safer conception program in an established public-sector HIV clinic in Uganda to inform future implementation. In-depth interviews and counseling observations explored experiences of program clients and healthcare providers to assess program acceptability, appropriateness, and feasibility. Fifteen index clients (8 women, 7 men), 10 pregnancy partners, and 10 providers completed interviews; 15 participants were living with HIV. Ten observations were conducted. We identified four emergent themes: (1) High demand for safer conception services integrated within routine HIV care, (2) Evolving messages of antiretroviral treatment as prevention contribute to confusion about HIV prevention options, (3) Gender and sexual relationship power inequities shape safer conception care, and (4) HIV-related stigma impacts safer conception care uptake. These findings confirm the need for safer conception care and suggest important implementation considerations.

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Data availability

The informed consent process did not allow for sharing of non-redacted transcripts for client participants. Data access requests for elements of raw data may be sent to the UAB Center for Clinical and Translational Science via CCTS@uab.edu; primary study authors may also be contacted. We would then provide redacted raw data responsive to specific requests. Because the provider interviews were conducted with a small group of providers from a small institution, we do not believe the interviews can be shared without jeopardizing confidentiality.

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Acknowledgements

We would like to dedicate this work to the late Dr. Mwebesa Bosco Bwana who dedicated his life to patient care and led our Healthy Families clinical and research team with the utmost compassion and conviction. We would also like to thank all of our participants and the Healthy Families team for their support throughout this project.

Funding

This publication was supported by the MGH ECOR, the Sullivan Family Foundation, National Institute of Allergy and Infectious Diseases (NIAID) (Grant Number T32 AI007433); and by the Global Women’s Health Fellowship of the Connor’s Center for Women’s Health and Gender Biology, at Brigham and Women’s Hospital. The Physician Scientist Development Short-Term Institutional Research Training Grant (T35 SHIRT) funded researcher Gill for this project.

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Author notes

  1. Cynthia R. Young and Elizabeth Gill contributed equally as first-authors.

Authors and Affiliations

  1. Division of Infectious Diseases, University of Kentucky, Lexington, KY, USA

    Cynthia R. Young

  2. School of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA

    Elizabeth Gill

  3. Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda

    Mwebesa Bwana & Winnie Muyindike

  4. Mbarara Regional Referral Hospital, Mbarara, Uganda

    Mwebesa Bwana, Winnie Muyindike & Alice Najjuma

  5. Division of Global Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Rebecca S. Hock & Silvia Natukunda

  6. Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda

    Moran Owembabazi & Deogratius Tukwasibwe

  7. Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda

    Paul Kalyebara

  8. Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada

    Angela Kaida

  9. Division of Infectious Diseases, University of Alabama At Birmingham, Birmingham, AL, USA

    Madeline C. Pratt & Lynn T. Matthews

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  1. Cynthia R. Young
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Contributions

CRY: conceptualization, data collection tool design, data collection, analysis, writing, final approval. EG: data analysis, writing, final approval. MB: conceptualization, data collection tool design, data collection, analysis, drafting. WM: analysis, writing, final approval. RSH: analysis, final approval. MCP: analysis, writing, final approval. MO; data collection tool design, data collection, analysis, writing, final approval. DT: conceptualization, data collection tool design, data collection, final approval. AN: conceptualization, data collection tool design, data collection, final approval. PK: data collection tool design, data collection, final approval. SN: data collection tool design, data collection, analysis, final approval. AK: data collection tool design, analysis, writing, final approval. LTM: conceptualization, data collection tool design, data collection, analysis, writing, final approval.

Corresponding author

Correspondence to Lynn T. Matthews.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All participants provided voluntary written informed consent at study enrollment. The Research Ethics Committee of Mbarara University of Science and Technology and the Partners Human Research Committee approved the study. Consistent with national guidelines, we received clearance for conducting our study from the Uganda National Council for Science and Technology and from the Research Secretariat in the Office of the President.

Consent to Participate

Through the Mbarara University of Science and Technology Institutional Review Committee informed consent forms were given to all volunteers. The consent form explained the research study and the volunteer role within the study. Different consent forms were created for clients/partners and providers. Categories for consent included: consent to participate in the study interview, consent to participate in the observation of a counselling session (client/partner only), consent to digital audio recording and consent to be contacted for future studies (client/partner only).

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Young, C.R., Gill, E., Bwana, M. et al. Client and Provider Experiences in Uganda Suggest Demand for and Highlight the Importance of Addressing HIV Stigma and Gender Norms Within Safer Conception Care. AIDS Behav 26, 76–87 (2022). https://doi.org/10.1007/s10461-021-03343-4

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