Population Council Research that makes a difference

Building on previous Council-sponsored work exploring the reproductive intentions of HIV-positive individuals, a qualitative study was conducted with women who recently received their first positive HIV test. Respondents had been enrolled in one of two clinical studies in South Africa sponsored by the Population Council at the time they tested positive for HIV: the Carraguard Phase 3 clinical trial and an assessment of audio computer-assisted self-interviewing versus face-to-face interviewing, which was conducted at the clinical trial sites. A sample was drawn of participants from the University of Cape Town (UCT) Empilisweni Centre for Wellness Studies and the University of Limpopo/Medunsa campus (Medunsa), Setshaba Research Centre. In-depth interviews were conducted with 39 HIV-infected women.

Our findings suggest that HIV diagnosis produced a major shift in sexual and reproductive desires, with the respondents almost unanimously reporting that they no longer wished for children. This can be attributed to five reoccurring themes: fear of orphaning their children, blame, guilt, concerns that their own health would be jeopardized by a pregnancy, and fear of community stigmatization. Fewer than half of the respondents were aware of prevention of mother-to-child transmission (PMTCT) programs. Difficulties negotiating safer sexual practices, combined with depression and anxiety, resulted in a loss of sexual desire. Respondents also reported a number of challenges in accessing services, including long queues, insensitive practitioners, and a fear of loss of confidentiality. The presence of ongoing support groups at the Medunsa site provided women with immediate care, which they credited with easier acceptance and ability to disclose their HIV status. No such on-site support group existed at UCT.

A manuscript presenting these findings is in preparation.

Project impact

Meeting the unique reproductive and sexual needs and rights of newly diagnosed women requires effective referral systems to ensure continuity of care and support. In addition to HIV services, HIV-positive women require counseling and information on effective contraceptive options, including emergency contraception and access to abortion, as well as PMTCT programs for those who wish to conceive. Ongoing care in HIV prevention trials must include family planning counseling and methods. Ultimately, a lack of continuity of care can lead to missed opportunities to provide health care and endangers the realization of sexual and reproductive rights.