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Author: Cooper D; Bracken H; Myer L; Zweigenthal V; Harries J
Source: Cape Town, South Africa, University of Cape Town, School of Public Health and Family Medicine, Women's Health Research Unit, 2005 Sep. 6 p. (Policy Brief) POPLINE: 291226
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Note: A study conducted at two health centers in the Cape Town metropolitan area in South Africa from May 2004 to January 2005 explored HIV-infected individuals’ reproductive intentions, decision-making, and need for reproductive health services. The study also gathered the opinions of health care providers and policy makers on the quality of services. The following is a summary of the study finding. Key points summarize the findings of the study.
Key Points:
Most HIV-infected women and men had not discussed their fertility desires and intentions with a health care provider because they anticipated negative reactions. Some women who had discussed reproduction with a health care provider found providers to be supportive of their reproductive choice. Others encountered providers who expressed negative attitudes towards HIV-infected women becoming pregnant..
Some women hesitated to use hormonal contraceptives because of perceived side effects or, among women on ART, fear of drug interactions. The quality of contraceptive counseling varied, and counseling did not appear to include much discussion of dual protection or emergency contraception. Some women complained about contraceptive services outside of the HIV care or treatment setting:They felt the range of contraceptive options was limited and there was little information on contraception in the context of HIV.
Women and men repeatedly mentioned the importance of using a condom to prevent HIV transmission and re-infection; providers, too, mentioned the great effort they put into promoting condom use. Individuals found it difficult, however, to reconcile safer sex messages with their desire to have children.
Many policy makers and health care providers were ambivalent in their opinions about HIV-infected women becoming pregnant. While acknowledging the need for women’s reproductive choice, some felt it unwise, with respect to public health, for HIV-infected women to become pregnant. Providers believed that they were, in fact, offering HIV-infected women reproductive choice. Several policy makers and providers recognized, however, that the emphasis with clients tended to be on the negative consequences of becoming pregnant.
Providers believed that, although counseling should be ongoing, the most crucial moments for counseling were before and after voluntary counseling and testing (VCT) and at the start of ART. Several nurses and counselors also mentioned the value of counseling.couples.
Policy makers noted concern about the lack of guidelines for dealing with reproductive choice among HIV-infected individuals, as well as about insufficient training in contraception, inadequate dual method counseling, and the scant reference made to emergency contraception. Some policy makers spoke of the need for values-clarification training for policy makers and health care providers, as part of ongoing training, to foster greater respect for client’s individual wishes and choices.
Without integration of voluntary counseling and testing (VCT) with routine reproductive health care or other services it was difficult to meet HIV-infected people’s comprehensive health care needs. Policy makers, NGO (nongovernmental organization) leaders, and public sector service managers remarked that many women only discovered their HIV status upon becoming pregnant.