Childbearing desires and experiences of people living with HIV and safer conception in Iringa, Tanzania
Saleem, Haneefa Tasleem
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Background: Many people living with HIV (PLHIV) continue to desire and have children after being diagnosed with HIV. Yet they often lack information on safer conception and face barriers accessing quality reproductive health services. Objectives: The overall objective of this dissertation was to explore childbearing desires and experiences of PLHIV and safer conception in Iringa, Tanzania. Manuscript one examines fertility desires of PLHIV. Manuscript two describes key features of the lived experience of having a child post-HIV diagnosis. Manuscript three explores whether and how international best practices and national childbearing and safer conception guidelines for PLHIV are implemented within HIV care and treatment facilities. Finally, manuscript four examines potential barriers to the adoption of safer conception strategies by HIV-affected couples using an ecological framework. Methods: Data were collected between June and October 2013 in Iringa, Tanzania. In-depth interviews were conducted with 30 HIV-infected women, 30 HIV-infected men, and 30 health care providers engaged in delivering HIV-related care. Direct observations were conducted at five health facilities. Results: Social and structural factors influenced fertility desires and childbearing experiences of women and men living with HIV. There are many factors unique to the experience of living with HIV that motivate and militate against PLHIV wanting more children. Significant gaps exist between Tanzania’s national HIV guidelines, recommendations for safer conception, and actual practices by health providers in delivering reproductive health care to PLHIV. There was limited patient-provider communication on childbearing and safer conception. Multiple barriers to safer conception for HIV-affected couples exist that operate at the individual, relational, environmental, structural, and superstructural levels. Conclusions: Integrating HIV and sexual and reproductive health services is critical to addressing the unique challenges encountered by PLHIV as they make decisions about reproduction. Health care providers can play an important role in assisting their HIV-infected patients safely conceive and deliver uninfected children by regularly assessing their fertility desires and providing safer conception counseling for couples. Findings highlight the need for updated national guidance on safer conception counseling for HIV-infected patients and training for health providers to prepare them for delivering high quality preconception counseling and safer conception services for their HIV-infected patients. Multi-level interventions are needed to ensure adoption of safer conception strategies and reduce the risk of HIV transmission between partners within HIV-affected couples.