Marseille 2007
Marseille 2007
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Abstract #201  -  Differences in Perceptions on Sexual and Reproductive Health between Health Care Workers and Persons Living with HIV: A Qualitative Study in the framework of the Eurosupport V Project
Session:
  10.6: Civil society and social ramifications (Parallel) on Monday @ 11.00-12.30 in CP Chaired by Liviana Calzavara, Ted Myers
Authors:
  Presenting Author:   PhD Christiana Noestlinger - Institute of Tropical Medicine, Belgium
 
  Additional Authors:  Dr Victoria Gordillo, Ms Ruth Borms, Mr Tom Platteau, Dr Robert Colebunders,  
Aim:
Women and couples living with HIV may want to plan pregnancy, limit the size of their family, or prevent pregnancy. As effective antiretroviral treatment leads to an increase in the desire to have children, sexual and reproductive health (SRH)-related issues increasingly have to be taken on in clinical HIV care. 15 study sites in 12 European countries participated in this qualitative study to assess perceptions on: 1) SRH-related problems and needs of persons living with HIV (PLWHA); 2) factors influencing SRH in this target group, 3) the actual SRH-service provision in clinical HIV-care settings.
 
Method / Issue:
Qualitative data were obtained using grounded theory as methodology and focus groups (FG) with health care workers (HCW) and PLWHA as data collection technique. Rigor of research in this cross-country setting was assured using a standardized protocol and training manual. Data were analyzed inductively using grounded theory at country level. An analytical ecological matrix was developed for the contextual analysis. At European level the approach of meta-ethnography was applied to identify common issues and cross cultural differences. We present here the results relating to reproductive health.
 
Results / Comments:
37 FG took place with a total of 257 participants (16 FG with 113 PLWHA; 21 FG with 144 HCW in total). Demographic characteristics of the participants were assessed by means of a short survey form. Problems and needs were identified on four different levels: intra-personal, interpersonal (partner and friends), provider-related, and context-related factors impacting on SRH-needs. Data show insufficient information regarding reproductive health care, i.e. ways to conceive while reducing the risk of HIV transmission, in particular in migrants. Discordant couples desiring pregnancy describe conceiving as conflicting with the wish to protect ones partner from HIV-transmission. Women and couples not wishing to conceive often lack adequate information on effective birth control methods, as HCW do not address dual protection on a regular basis. In general, PLWHA perceive SRH-issues as not sufficiently addressed in clinical HIV care, while access to quality gynecological/obstetrical care is restricted. Lack of coverage of assisted reproduction technologies through health insurances in specific countries is perceived as a further obstacle. HCW are confronted with a general lack of resources (time, specific training, support); which makes them feel inadequately equipped to take on SRH issues.
 
Discussion:
PLWHA, in particular those who acquired HIV through heterosexual transmission, perceive SHR-related problems as decreasing their quality of life, influencing SRH-choices and future life perspectives. While from patients perception SRH is a prioritized issue, these issues rarely come up during routine HIV care in health care settings with a dominant bio-medical approach. HCW need adequate counseling training to tackle SRH-related issues. A better integration between HIV care programs and SRH care settings is needed to improve the effective service provision.
 
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