Toward improved reproductive health care for HIV-infected individuals in developing countries

Background

Addressing HIV-infected individuals’ reproductive health needs is an urgent concern in countries with advanced HIV epidemics, where a sizeable population early in their reproductive years is already HIV-positive. While access to antiretroviral drugs has begun to normalize the lives of HIV-infected people, issues of contraception and childbearing are often sidelined. The aim of this study was to describe health provider’s knowledge and perceptions about fertility intentions, contraception and reproductive health care of HIV-infected women and men.

 Methods

Structured interviews were conducted with 70 primary care providers working in public sector facilities in Cape Town. Issues explored included: types of reproductive health services provided, attitudes towards fertility intentions of HIV-infected individuals, reproductive health topics discussed, knowledge of reproductive health and HIV issues and perceived training needs.

 Results

Most participants provided contraceptive advice, other reproductive health services and HIV care. When asked about HIV-infected people wanting biological children: 26% of providers felt positively about this, 34% felt negatively and 40% had mixed feelings. Reasons for negative feelings were related to concerns about transmission of HIV and issues related to child rearing; mixed feelings were related to balancing the individual’s right to have a child with the risk of transmission. Providers reported discussing issues related to safe sex, plans for childbearing and contraception with clients. Fewer providers discussed issues around unplanned pregnancy and difficulties in conceiving. Provider knowledge on contraceptive use in HIV positive clients was sub-optimal. Participants reported that they were unaware of existing policies that addressed reproductive health needs of HIV-infected individuals and most would welcome training in this area.

Conclusions

This study highlights the need for guidelines and provider training on reproductive health needs of HIV-positive individuals. Findings are being used to strengthen the capacity of primary care providers to better manage reproductive health needs of HIV- infected individuals.