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      Fertility intentions of prenatal and postpartum HIV-positive women in primary care in Mpumalanga province, South Africa: a longitudinal study

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          Abstract

          Introduction

          This study aimed to assess fertility intentions (planning to have more children in the future) and associated factors among pregnant and postpartum HIV positive women in rural South Africa.

          Methods

          In a longitudinal study, as part of a prevention of mother to child transmission (PMTCT) intervention trial, 699 HIV positive prenatal women, were systematically recruited and followed up at 6 months and 12 months postpartum (retention rate = 59.5%).

          Results

          At baseline, 32.9% of the women indicated fertility intentions and at 12 months postnatal, 120 (28.0%) reported fertility intentions. In longitudinal analyses, which included time-invariant baseline characteristics predicting fertility intention over time, not having children, having a partner with unknown/HIV-negative status, and having disclosed their HIV status to their partner, were associated with fertility intentions. In a model with time-varying covariates, decreased family planning knowledge, talking to a provider about a future pregnancy, and increased male involvement were associated with fertility intentions.

          Conclusion

          Results support ongoing perinatal family planning and PMTCT education.

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          Most cited references55

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          Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale.

          J Cox, J. Holden, R Sagovsky (1987)
          The development of a 10-item self-report scale (EPDS) to screen for Postnatal Depression in the community is described. After extensive pilot interviews a validation study was carried out on 84 mothers using the Research Diagnostic Criteria for depressive illness obtained from Goldberg's Standardised Psychiatric Interview. The EPDS was found to have satisfactory sensitivity and specificity, and was also sensitive to change in the severity of depression over time. The scale can be completed in about 5 minutes and has a simple method of scoring. The use of the EPDS in the secondary prevention of Postnatal Depression is discussed.
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            Development and psychometric evaluation of the brief HIV Knowledge Questionnaire.

            Michael Carey, Kerstin E. E. Schroder (2002)
            This research evaluated the psychometric properties of a brief self-report measure of HIV-related knowledge, the 18-item HIV Knowledge Questionnaire (HIV-KQ-18). Low-income men and women (N = 1,019) responded to 27 items that represented the domain of interest. Item analyses indicated that 18 items, with item-total correlations ranging from .24 to .57, be retained. Additional analyses demonstrated the HIV-KQ-18's internal consistency across samples (alphas = .75-.89), test-retest stability across several intervals (rs = .76- .94), and strong associations with a much longer, previously validated measure (rs = .93-.97). Data from three clinical trials indicated that the HIV-KQ-18 detected knowledge gains in treated participants when compared to untreated controls. We conclude that the HIV-KQ-18 is internally consistent, stable, sensitive to the change resulting from intervention, and suitable for use with low-literacy populations.
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              "Life is still going on": reproductive intentions among HIV-positive women and men in South Africa.

              Landon Myer, Virginia Zweigenthal, Phyllis Orner … (2007)
              This article reports on qualitative research investigating HIV positive individuals' reproductive intentions and their influencing factors in Cape Town, South Africa. In-depth interviews were held with 61 HIV positive women and men; at the time of interview, half had been receiving antiretroviral treatment (ART) for over 6 months and half were not receiving ART. Being HIV positive modified but did not remove reproductive desires, and diversity existed in reproductive intentions. Some HIV positive individuals wished to avoid pregnancy. Fears of partner and infant infection and having a previously infected baby were important factors deterring some individuals from considering having children. There was also strongly perceived community disapproval associated with HIV and reproduction. Strong desires to experience parenthood, mediated by prevailing social and cultural norms that encouraged childbearing in society more broadly, were reported by others. Motherhood was an important component of married women's identity and important for women's social status. Family, husbands' and societal expectations for childbearing were important influences on women's reproductive intentions, for some counterbalancing HIV as a factor discouraging reproduction. There was evidence that prevention of perinatal transmission programs in combination with ART may alter women and men's attitudes in favour of childbearing. Most HIV positive women had not discussed their reproductive desires and intentions with health care providers in HIV care or general health services because of anticipated negative reactions. The few who had done so perceived the counselling environment to be mostly unsupportive of open discussion on these issues. The findings highlight the need for explicit policies recognizing reproductive rights and choice. They support the need for health counselling and service interventions that advance safer and healthier reproductive options for HIV positive individuals in this region of the world which is experiencing a generalised and advanced HIV/AIDS pandemic.
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                Author and article information

                Journal
                Journal ID (nlm-ta): HIV AIDS (Auckl)
                Journal ID (iso-abbrev): HIV AIDS (Auckl)
                Journal ID (publisher-id): HIV/AIDS - Research and Palliative Care
                Title: HIV/AIDS (Auckland, N.Z.)
                Publisher: Dove Medical Press
                ISSN (Electronic): 1179-1373
                Publication date Collection: 2018
                Publication date (Electronic): 16 February 2018
                Volume: 10
                Pages: 9-17
                Affiliations
                [1 ]HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, South Africa
                [2 ]Department of Research and Innovation, University of Limpopo, Sovenga, South Africa
                [3 ]Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
                [4 ]Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
                [5 ]School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
                Author notes
                Correspondence: Stephen M Weiss, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Avenue, Miami, FL 33136, USA, Email sweiss2@ 123456med.miami.edu
                Article
                Publisher ID: hiv-10-009
                DOI: 10.2147/HIV.S153212
                PMC ID: 5818871
                SO-VID: 96476b60-1237-4b26-b9e1-f0a985151629
                Copyright © © 2018 Peltzer et al. This work is published and licensed by Dove Medical Press Limited
                License:

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Subject: Original Research

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: fertility intentions,family planning,hiv infection,pregnancy,south africa,male involvement
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: fertility intentions, family planning, hiv infection, pregnancy, south africa, male involvement

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