Population Council Research that makes a difference

2011 International Conference on Family Planning
29 November–2 December 2011

Abstract

"Fertility intentions and family planning practices among HIV positive women in Kenya"
Manuela Colombini, Richard Mutemwa, Jackie Kivunaga, and Susannah H. Mayhew

Background
Despite several initiatives integrating HIV and SRH services, little attempt has been made to focus on women’s experiences and the impact on their lives. This study explores the experiences of HIV positive clients to understand implications of a positive HIV diagnosis for family planning practices and fertility intentions and whether integrated services better respond to their reproductive needs.

Methods
In-depth interviews were conducted with 26 HIV positive women who are part of a larger cohort study initially recruited while attending for integrated HIV/FP services at 12 health facilities in Central Province, Kenya. Data were coded using Nvivo 8 and analysed using a thematic analysis.

Results
Preliminary findings suggest that, in general, the fertility intentions of the HIV positive women interviewed are modified by an HIV diagnosis. Nearly all of the women interviewed reported reduced desires for additional pregnancies following an HIV positive test outcome. Reasons cited for these changes in pregnancy intentions varied, ranging from fears related to their HIV status, such as fear of peri-natal HIV transmission or impacting on their own health status, to socio-cultural concerns including stigma. Moreover, as a consequence of their HIV positive status, many of them said they changed their sexual behaviour and started using condoms to prevent re-infection of the virus and some to avoid pregnancy. Still, some women do not see condom use as the only way to prevent pregnancy. As a consequence of reduced fertility desires and fear of HIV reinfection, the data suggest that dual method use is successfully practised by many women in this population.

Conclusions
These findings suggest that fertility intentions of HIV positive women are modified by the positive HIV diagnosis. The HIV positive test outcome also tends to make the women more aware of the need to use condoms to prevent HIV re-infection. Many of them also use condoms to prevent pregnancy. What cannot be said conclusively however is the extent to which these changes among HIV positive women depend on whether an HIV positive woman is attending integrated or stand alone SRH services. A subsequent quantitative study will be used to test whether integration is more effectively promoting dual method use compared to stand-alone FP sites.

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