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“If I don’t use a condom … I would be stressed in my heart that I’ve done something wrong”: Routine Prevention Messages Preclude Safer Conception Counseling for HIV-Infected Men and Women in South Africa

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Abstract

Intended conception likely contributes to a significant proportion of new HIV infections in South Africa. Safer conception strategies require healthcare provider–client communication about fertility intentions, periconception risks, and options to modify those risks. We conducted in-depth interviews with 35 HIV-infected men and women accessing care in South Africa to explore barriers and promoters to patient–provider communication around fertility desires and intentions. Few participants had discussed personal fertility goals with providers. Discussions about pregnancy focused on maternal and child health, not sexual HIV transmission; no participants had received tailored safer conception advice. Although participants welcomed safer conception counseling, barriers to client-initiated discussions included narrowly focused prevention messages and perceptions that periconception transmission risk is not modifiable. Supporting providers to assess clients’ fertility intentions and offer appropriate advice, and public health campaigns that address sexual HIV transmission in the context of conception may improve awareness of and access to safer conception strategies.

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Abbreviations

ART:

Antiretroviral therapy

PrEP:

Pre-exposure prophylaxis

MMC:

Medical male circumcision

PLWH:

People living with HIV

PMTCT:

Preventing mother-to-child transmission

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Acknowledgments

The authors thank the clients who participated in this study and the MatCH research team that participated in data collection and preparation.

Disclosures

This study was supported by the NICHD (R03-HD072602) and the Canadian African Sub-Saharan Africa AIDS Network. The analysis was also supported by NIH Grants K23 MH095655, K24MH87227, K24MH094214, and K23MH096651. The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflict of interest

The authors report no conflicts of interest.

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Authors and Affiliations

  1. Center for Global Health and Division of Infectious Disease, Massachusetts General Hospital, 100 Cambridge Street, 15th Floor, Boston, MA, 02114, USA

    L. T. Matthews, R. Rifkin & D. R. Bangsberg

  2. MatCH Research (Maternal, Adolescent and Child Health Research), University of the Witwatersrand, Durban, South Africa

    L. Moore, C. Milford, R. Greener, F. N. Mosery & J. A. Smit

  3. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    C. Psaros & S. A. Safren

  4. School of Public Health, Brown University, Providence, RI, USA

    A. Harrison

  5. Department of Medicine, Brown University, Providence, RI, USA

    I. B. Wilson

  6. Harvard Medical School, Boston, MA, USA

    L. T. Matthews, C. Psaros, S. A. Safren & D. R. Bangsberg

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  1. L. T. Matthews
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  2. L. Moore
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  3. C. Milford
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  10. I. B. Wilson
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Correspondence to L. T. Matthews.

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Matthews, L.T., Moore, L., Milford, C. et al. “If I don’t use a condom … I would be stressed in my heart that I’ve done something wrong”: Routine Prevention Messages Preclude Safer Conception Counseling for HIV-Infected Men and Women in South Africa. AIDS Behav 19, 1666–1675 (2015). https://doi.org/10.1007/s10461-015-1026-x

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