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Knowing Client Rights and Meeting Their Needs: Provider Knowledge and Attitudes Toward Meeting the Reproductive Needs and Rights of People Living with HIV in South Africa

Chapter

Abstract

With the widespread availability of antiretroviral treatment (ART), men and women living with HIV are living longer and healthier lives. Many of these men and women are of reproductive age and are having children or expressing the desire for children. Prevention of mother-to-child transmission (PMTCT) care has focused on preventing HIV transmission to children. A critical next step is addressing horizontal transmission between partners during conception. Providers face many challenges in the delivery of care to PLHIV which is further complicated by the call to address their reproductive needs. Despite the call to integrate HIV and reproductive health services the integration of such services faces many challenges, still falling far short of meeting the reproductive rights and needs of clients. We conducted focus group and in-depth qualitative interviews with 25 health care providers in a rural and urban ARV clinic in KwaZulu-Natal. We found that health care providers struggled to balance their perceptions of client reproductive rights and their personal attitudes and professional experiences in addressing these needs. Furthermore, despite the publication of national guidelines for safer conception, health care providers still have limited knowledge or training in safer conception strategies for PLHIV. This chapter highlights provider ambivalence in knowing and meeting reproductive rights and needs of PLHIV.

Keywords

PLHIV Reproductive rights Safer conception Health care providers South Africa 

References

  1. Ahanonu, E. L. (2014). Attitudes of Healthcare Providers towards Providing Contraceptives for Unmarried Adolescents in Ibadan, Nigeria. Journal of Family & Reproductive Health, 8(1), 33–40.Google Scholar
  2. Barron, P., Pillay, Y., Doherty, T., Sherman, G., Jackson, D., Bhardwaj, S., Robinson, P., & Goga, A. (2013). Eliminating mother to child transmission in South Africa. Bulletin of the World Health Organization, 91(1), 70–74. doi: 10.2471/BLT.12.106807.
  3. Bekker, L., Black, V., Myer, L., Rees, H., Cooper, D., Mall, S., ... Schwartz, S. (2011). Guideline on safer conception in fertile HIV-infected individuals and couples. South African Journal of HIV Medicine, 12, 31–44.Google Scholar
  4. Bernard, H. R., & Ryan, G. W. (2010). Analyzing qualitative data: Systematic approaches. Thousand Oaks, CA: Sage.Google Scholar
  5. Bharat, S., & Mahendra, V. S. (2007). Meeting the sexual and reproductive health needs of people living with HIV: challenges for health care providers. Reproductive Health Matters, 15(29), 93–112.CrossRefPubMedGoogle Scholar
  6. Caldwell, J. (1976). Towards the restatement of the Demographic Transition Theory. Population and Development Review, 2(3), 361–366.Google Scholar
  7. Cooper, D., Morroni, C., Orner, P., Moodley, J., Harries, J., Cullingworth, L., & Hoffman, R.M. (2004). Ten Years of Democracy in South Africa: Documenting Transformation in Reproductive Health Policy and Status. Reproductive Health Matters, 12(24), 70–85.Google Scholar
  8. Cooper, D., Harries, J., Myer, L., Orner, P., & Bracken, H. (2007). “Life is still going on”: Reproductive intentions among HIV-positive women and men in South Africa. Social Science and Medicine, 65, 274–283.CrossRefPubMedGoogle Scholar
  9. Cooper, D., Moodley, J., Zweigenthal, V., Bekker, L., Shah, I., & Myer, L. (2009). Fertility intentions and reproductive health care needs of people living with HIV in Cape Town, South Africa: implications for integrating reproductive health and HIV care services. AIDS and Behavior, 13(Suppl 1), 38–46.CrossRefPubMedGoogle Scholar
  10. Crankshaw, T. L., Mindry, D., Munthree, C., Letsoalo, T., & Maharaj, P. (2014). Challenges with couples, serodiscordance and HIV disclosure: Healthcare provider perspectives on delivering safer conception services for HIV-affected couples, South Africa. Journal of the International AIDS Society, 17, 18832.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Creel, L. C., Sass, J. V., & Yinger, N. V. (2002). Overview of quality of care in reproductive health: definitions and measurements of quality. New Perspectives on Quality of Care, 1, 1–8.Google Scholar
  12. Davies N, Mullick S, Schwartz S. (2016). Uptake and clinical outcomes from a primary healthcare based safer conception service in Johannesburg, South Africa: findings at 7 months. Proceedings of the 2016 Conference of the International AIDS Society; 2016 July 18–22; Durban, South Africa.Google Scholar
  13. Dinh, T. H., Delaney, K. P., Goga, A., Jackson, D., Lombard, C., Woldesenbet, S., … Shaffer, N. (2015). Impact of maternal HIV seroconversion during pregnancy on early mother to child transmission of HIV (MTCT) measured at 4–8 weeks postpartum in South Africa 2011–2012: A national population-based evaluation. PloS One, 10(5), e0125525. doi: 10.1371/journalpone.0125525.
  14. Edouard, L., & Bernstein, S. (2015). Sexual and reproductive health at 2015 and beyond: a global perspective. Journal of Obstetrics and Gynaecology Canada, 37(10), 872–879.CrossRefPubMedGoogle Scholar
  15. Finocchario-Kessler, S., Dariotis, J. K., Sweat, M. D., Trent, M. E., Keller, J. M., Hafeez, Q., & Anderson, J. R. (2010). Do HIV-infected women want to discuss reproductive plans with providers, and are those conversations occurring? AIDS Patient Care and STDs, 24(5), 317–323.Google Scholar
  16. Finocharrio-Kessler, S., Wanyenza, R., Mindry, D., Biyeza-Kashesya, J., Goggin, K., Nabiryo, K., & Wagner, G. (2014). “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 for Women International, Supplement: Women and Health in Africa, 35(7–9), 896–917.Google Scholar
  17. Gilson, L., Doherty, J., Lake, S., McIntyre, D., Mwikisa, C., & Thomas, S. (2003). The SAZA study: implementing health financing reform in South Africa and Zambia. Health Policy and Planning, 18(1), 31–46.CrossRefPubMedGoogle Scholar
  18. Goga, A. E., Dinh, T. H., Jackson, D. J., Lombard, C., Delaney, K. P., Puren, A., … PMTCT Evaluation Team, South Africa. (2015). First population-level effectiveness evaluation of a national programme to prevent HIV transmission from mother to child, South Africa. Journal of Epidemiology and Community Health, 69(3), 240–248. doi: 10.1136/jech-2014-204535 CrossRefPubMedGoogle Scholar
  19. Goggin, K., Mindry, D., Beyeza-Kashesya, J., Finoccario-Kessler, S., Wanyenze, R., Nabiryo, C., & Wagner, G. (2014). “Our hands are tied up”: Current state of safer conception services suggests the need for an integrated care model. Health Care for Women International, Supplement: Women and Health in Africa, 35, 990–1009. doi: 10.1080/07399332.2014.920023.
  20. Gruskin, S., Ferguson, R., & O’Malley, J. (2007). Ensuring sexual and reproductive health for people living with HIV: An overview of key human rights issues, policy and health systems issues. Reproductive Health Matters, 15(29), 4–26.CrossRefPubMedGoogle Scholar
  21. Harries, J., Stinson, K., & Orner, P. (2009). Health care providers’ attitudes towards termination of pregnancy: A qualitative study in South Africa. BMC Public Health, 9(1), 296–307. doi: 10.1186/1471-2458-9-296.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Harrison, A., Montgomery, E. T., Lurie, M., & Wilkinson, D. (2000). Barriers to implementing South Africa’s termination of pregnancy act in rural KwaZulu/Natal. Health Policy and Planning, 15(4), 424–431. doi: 10.1093/heapol/15.4.424.CrossRefPubMedGoogle Scholar
  23. Hosegood, V., McGrath, N., & Moultrie, T. (2009). Dispensing with marriage: Marital and partnership trends in rural KwaZulu-Natal, South Africa 2000-2006. Demographic Research, 20, 279–312.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Houle, B., Pantazas, A., Kabudula, C., Tollman, S., & Clark, S. J. (2016). Social patterns and differentials in the fertility transition in the context of HIV/AIDS: evidence from population surveillance, rural South Africa, 1993 – 2013. Population Health Metrics, 14, 10. doi: 10.1186/s12963-016-0079-z.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Ibisomi, L., Williams, J., Collinson, M. A., & Tollman, S. (2014). The stall in fertility decline in rural, northeast, South Africa: the contribution of a self-settled, Mozambican, refugee sub-population. Etude de la Population Africaine, 28(1), 590.CrossRefGoogle Scholar
  26. Jewkes, R., Vundule, C., Maforah, F., & Jordaan, E. (2001). Relationship dynamics and teenage pregnancy in South Africa. Social Science and Medicine, 52(5), 733–744.CrossRefPubMedGoogle Scholar
  27. Kaida, A., Laher, F., Strathdee, S. A., Janssen, P. A., Money, D., Hogg, R. S., & Gray, G. (2011). Childbearing intentions of HIV-positive women of reproductive age in Soweto, South Africa: the influence of expanding access to HAART in an HIV hyperendemic setting. American Journal of Public Health, 101(2), 350–358.Google Scholar
  28. Kawale, P., Mindry, D., Stramotas, S., Chilikoh, P., Phoya, A., Henry, K., … Hoffman, R. (2013). Factors associated with desire for children among HIV-infected women and men: A quantitative and qualitative analysis from Malawi and implications for the delivery of safer conception counseling. AIDS Care, 26(6), 769–776.Google Scholar
  29. Kawale, P., Mindry, D., Phoya, A., Jensen, P., & Hoffman, R. M. (2015). Provider attitudes about childbearing and knowledge of safer conception at two HIV clinics in Malawi. Journal of Reproductive Health, 12, 17. doi: 10.1186/s12978-015-0004-0.CrossRefPubMedGoogle Scholar
  30. Kongnyuy, E. J., & Wiysonge, C. S. (2008). Association between fertility and HIV status: what implications for HIV estimates? BMC Public Health, 8(1), 1.CrossRefGoogle Scholar
  31. Knudsen, L. M. (2006). Reproductive rights in a global context: South Africa, Uganda, Peru, Denmark, United States, Vietnam, Jordan. Nashville: Vanderbilt University Press.Google Scholar
  32. Kushnir, V. A., & Lewis, W. (2011). Human immunodeficiency virus/acquired immunodeficiency syndrome and infertility: emerging problems in the era of highly active antiretrovirals. Fertility and Sterility, 96(3), 546–553.CrossRefPubMedPubMedCentralGoogle Scholar
  33. McIntyre, D., & Klugman, B. (2003). The human face of decentralisation and integration of health services: Experience from South Africa. Reproductive Health Matters, 11(21), 108–119.CrossRefPubMedGoogle Scholar
  34. Mindry, D., Maman, S., Chirowodza, A., Muravha, T., van Rooyen, H., & Coates, T. (2011). Looking to the future: South African men and women negotiating HIV risk and relationship intimacy. Culture, Health and Sexuality, 13(5), 589–602.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Mindry, D., Crankshaw, T. L., Maharaj, P., Munthree, C., Lestsoalo, T., Milford, C., … Smit, J. A. (2015). “We have to try and have this child before it is too late”: The social dimensions of reproductive decisions and safer conception services for PLHIV. AIDS Care, 27(1), 25–30.Google Scholar
  36. Mkhize, N. (2006). African traditions and the social, economic and moral dimensions of fatherhood. In R. Morrell & L. Richter (Eds.), Baba: Men and fatherhood in South Africa (pp. 183–198). Cape Town: HSRC Press.Google Scholar
  37. Morrell, R. (2006). Fathers, fatherhood and masculinity in South Africa. In R. Morrell & L. Richter (Eds.), Baba: Men and fatherhood in South Africa (pp. 13–25). Cape Town: HSRC Press.Google Scholar
  38. Myer, L., Morroni, C., & Rebe, K. (2007). Prevalence and determinants of fertility intentions of HIV-infected women and men receiving antiretroviral therapy in South Africa. AIDS Patient Care and STDs, 21(4), 278–285.CrossRefPubMedGoogle Scholar
  39. Myer, L., Carter, R. J., Katyal, M., Toro, P., El-Sadr, W. M., & Abrams, E. J. (2010). Impact of antiretroviral therapy on incidence of pregnancy among HIV-infected women in sub-Saharan Africa: A cohort study. PLoS Medicine, 7(2), e1000229. doi: 10.1371/journal.pmed.1000229.CrossRefPubMedPubMedCentralGoogle Scholar
  40. NDoH. (2012). Saving mothers 2008–2010: Fifth comprehensive report on confidential enquiries into maternal deaths in South Africa. Pretoria, South Africa: National Department of Health.Google Scholar
  41. NDoH. (2015). Annual report 2014/2015. Pretoria, South Africa: National Department of Health. Retrieved July 8, 2016, from http://www.health.gov.za/index.php/2014-03-17-09-09-38/2014-03-17-09-24-31/category/239-ar2015.
  42. Nduna, N., & Farlane, L. (2009). Women living with HIV in South Africa and their concerns about fertility. AIDS and Behavior, 13, S62–S65.CrossRefGoogle Scholar
  43. Ngobese, R. W. (2009). Zulu people. Retrieved October 28, 2013, from http://uir.unisa.ac.za/bitstream/handle/10500/1263/02appendices.pdf?sequence=3
  44. Orner, P., Cooper, D., Myer, L., Zweigenthal, L., Bekker, L. G., & Moodley, H. (2008). Client’s perspectives on HIV/AIDS care and treatment and reproductive health services in South Africa. AIDS Care, 20(10), 1217–1223.CrossRefPubMedGoogle Scholar
  45. Preston-Whyte, E., & Zondi, M. (1989). To control their own reproduction: The agenda of black teenage mothers in Durban. Agenda, 4, 47–68.Google Scholar
  46. Preston-Whyte, E. (1993). Women who are not married: fertility, ‘illegitimacy’, and the nature of households and domestic groups among single African women in Durban. South African Journal of Sociology, 24(3), 63–71.CrossRefGoogle Scholar
  47. Ryan, G., & Bernard, H. (2003). Techniques to identify themes. Field Methods, 15, 85–109.CrossRefGoogle Scholar
  48. Schwartz, S. R., Mehta, S. H., Taha, T. E., Rees, H. V., Venter, F., & Black, V. (2011). 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 and Behavior, 16(1), 69–78. doi: 10.1007/s10461-011-9981-3.
  49. Schwartz S. R., Yende N, Bassett J, Sanne I, Van Rie A. (2016). Clinical outcomes and lessons learned from a safer conception clinic for HIV-affected couples trying to conceive. Proceedings of the 2016 Conference of the International AIDS Society, 2016 July 18–22, Durban, South Africa.Google Scholar
  50. Stack, L., & Hlela, K. (2002). Enhancing policy implementation: Lessons from the health sector, Research Report No. 94. Johannesburg: Centre for policy study.Google Scholar
  51. Statistics South Africa. (2016). Statistical release P0302: Mid-year population estimates, 2016. Pretoria: South Africa. Retrieved June 20, 2017, from http://www.statssa.gov.za/publications/P0302/P03022016.pdf.
  52. Turner, K. L., Hyman, A. G., & Gabriel, M. C. (2008). Clarifying values and transforming attitudes to improve access to second trimester abortion. Reproductive Health Matters, 16(31), 108–116.Google Scholar
  53. UNAIDS. (2016). Update on the global AIDS epidemic, 2016. Retrieved from http://www.unaids.org/sites/default/files/media_asset/global-AIDS-update-2016_en.pdf.
  54. Van den Berg, W., Brittain, K., Mercer, G., Peacock, D., Stinson, K., Janson, H., & Dubula, V. (2015). Improving men’s participation in preventing mother-to-child transmission of HIV as a maternal, neonatal, and child health priority in South Africa. PLoS Medicine, 12(4), e1001811. doi: 10.1371/journal.pmed.1001811
  55. van der Vliet, V. (1991). Traditional husbands, modern wives—Constructing marriages in a South African township. African Studies, 50(1–2), 219–241.Google Scholar
  56. Villar-Loubet, O. M., Bruscantini, L., Shikwane, M. E., Weiss, S., Peltzer, K., & Jones, D. L. (2013). HIV disclosure, sexual negotiation and male involvement in prevention-of-mother-to-child-transmission in South Africa. Culture, Health & Sexuality, 15(3), 253–268. doi: 10.1080/13691058.2012.716166.CrossRefGoogle Scholar
  57. Weisberg, E., Fraser, I. S., Carric, S. E., & Wilde, F. M. (1995). Emergency contraception, general practitioner knowledge, attitude and practices in New South Wales. Medical Journal of Australia, 162, 136–138.Google Scholar
  58. World Health Organization. (2001). Annual technical report 2000: Department of reproductive health and research, including UNDP/UNFPA/WHO/World Bank Special Programme of Research Training in Human Reproduction (HRP). Geneva: World Health Organization.Google Scholar
  59. Zaba, B., & Gregson, S. (1997). Measuring the impact of HIV on fertility in Africa. AIDS (London, England), 12, S41–S50.Google Scholar

Suggested Reading

  1. Clouse, K., Schwartz, S., Van Rie, A., Bassett, J., Yende, N., & Pettifor, A. (2014). “What they wanted was to give birth; nothing else”: barriers to retention in option B+ HIV care among postpartum women in South Africa. JAIDS Journal of Acquired Immune Deficiency Syndromes, 67(1), e12–e18.Google Scholar
  2. Cooper, D., Mantell, J. E., Moodley, J., & Mall, S. (2015). The HIV epidemic and sexual and reproductive health policy integration: views of South African policymakers. BMC Public Health, 15(1), 1.CrossRefGoogle Scholar
  3. Schwartz, S. R., Bassett, J., Sanne, I., Phofa, R., Yende, N., & Van Rie, A. (2014). Implementation of a safer conception service for HIV-affected couples in South Africa. AIDS (London, England), 28(Suppl 3), S277.Google Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Center for Social Medicine and Humanities, Semel InstituteUniversity of CaliforniaLos AngelesUSA
  2. 2.School of Built Environment and Development StudiesUniversity of KwaZulu-NatalDurbanSouth Africa
  3. 3.Health Economics and HIV/AIDS Research Division (HEARD)University of KwaZulu-NatalDurbanSouth Africa

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