Reproductive Choices For Women Living with HIV on ART: The Views of Providers and Clients on Contraception and Fertility

Abstract

Objective: The main objective of this study was to assess the reproductive choices for Women Living with HIV on ART in the urban health centres within Lusaka. Methods: Nine hundred and fifty six HIV-positive women receiving care in the zoned health centres were randomly sampled and 12 health care workers who were purposefully sampled and were available in the ART setting participated in the study. A survey questionnaire, in-depth interviews and focus group discussions were the main data collection tools used. Quantitative data was analysed using SPSS while qualitative data was analysed using qualitative content analysis rooted in grounded theory (Precaution Adoption Model (PAPM). Results: The majority of the respondents in this study n = 503 (64%) felt that it was important to be safe from becoming pregnant whereas n = 429 (46%) felt that it was not. Health workers counselled the respondents on nearly all of the available contraceptive methods, with an emphasis on the oral pill, injectable hormonal drug, and on male and female condoms – with the greatest emphasis on the male condom. The reasons that women had for selecting particular family planning methods varied temporally. Some women engaged in unprotected sex because their partner was also HIV seropositive. Even in situations when an HIV-positive woman was told of her sero status and given counselling on the risks of mother-to-child-transmission (MTCT), the majority of women would still engage in unprotected sex that often led to pregnancy. Nurses preferentially discouraged the women from getting pregnant using the counselling methods described. The rationale for the counselling methods was based on age, education, medical and gynaecological complications. In the current health care setup, it was not demonstrated that reproductive health issues of people living with HIV and AIDS could be provided within the ART clinic. Conclusion: As HIV continues to spread among women of childbearing age, there is an increasing need for support programs for infected women regarding sex, safer sex, pregnancy and family planning. The healthcare challenges for this group must be addressed with a two-pronged approach- women must prioritize the risk to their health with repeated exposures to HIV and the healthcare workers must empower them to make these decisions. For this to occur, it is crucial that HIV positive women have easy access to reproductive healthcare counselling in juxtaposition to the ART Clinic. The health care workers that directly counsel these women have a pivotal role in addressing these concerns. Nursing professionals who comprise the bulk of healthcare workers providing these services can play a major role in meeting these needs.