Fertility Intentions among HIV-positive women in Atlanta - A Qualitative Study 公开

Umpierrez, Denise (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/9306sz52v?locale=zh
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Abstract

With the changing landscape of survival and HIV treatment options, there is an increasing need to address reproductive health and fertility desires of HIV-positive women. This thesis explores the factors influencing fertility desires of African American HIV-positive women in Atlanta, GA. Four focus group discussions and nine in-depth interviews were conducted with 27 women. HIV-positive women faced issues that women without HIV consider when making pregnancy decisions as well as concerns related to having HIV. The main positive force driving pregnancy was the value of and desire for motherhood. The biggest deterrent to childbearing was vertical HIV transmission. Knowledge of antiretroviral treatment (ART) and the perception of being able to have a baby born without HIV was also a key influencer of fertility intentions for women, especially if the woman had not achieved her fertility intentions when she was diagnosed with HIV. Other factors that modify the women's fertility desires and behaviors included age, parity, money, and religiosity, and perceptions about condoms and family planning methods. Partners had a moderate influence on fertility; however, decisions were often made irrespective of partner considerations. Partners enabled women to achieve their fertility desires by agreeing to unprotected sex; in fact, they often requested unprotected sex and it was the women who pushed for condom use. Although less important than vertical transmission, partner transmission of HIV was also considered when making fertility decisions. Families had little influence on the women's fertility desires and plans.

The findings highlighted that HIV modified pregnancy desires but it far from removed them and that providers were not optimally addressing fertility desires, pre-conception counseling, safe practices, or contraception. The study also underscored how improved understanding of and treatments for HIV have led to increased desires for fertility among HIV-positive women but that many misconceptions still exist and need to be better addressed by healthcare providers and health education support groups.

Table of Contents

CHAPTER 1: INTRODUCTION.................................................................................... 1

CHAPTER 2: COMPREHENSIVE LITERATURE REVIEW...................................................... 3

CHAPTER 3: PROJECT CONTENT............................................................................... 10

METHODS............................................................................................................ 10

RESULTS............................................................................................................. 15

RESULTS SYNOPSIS.............................................................................................. 15

GENERAL FACTORS INFLUENCING FERTILITY INTENTIONS............................................. 16

Value of motherhood & desire for pregnancy............................................................. 16

Age.................................................................................................................... 17

Parity................................................................................................................. 17

Finances............................................................................................................. 18

Religiosity........................................................................................................... 18

Family and social influences................................................................................... 19

Partner influences................................................................................................ 19

Family planning method knowledge and use.............................................................. 21

Family planning method education........................................................................... 24

FACTORS INFLUENCING FERTILITY INTENTIONS SPECIFIC TO HIV-POSITIVE WOMEN......... 25

Vertical HIV transmission & antiretroviral therapy (ART)............................................. 25

Personal experience with HIV & Pregnancy................................................................ 28

Personal health status........................................................................................... 29

Unplanned Pregnancy............................................................................................ 30

Termination of Pregnancy....................................................................................... 31

Partner transmission & condom use......................................................................... 32

CHAPTER 4: CONCLUSION AND RECOMMENDATIONS................................................... 36

DISCUSSION........................................................................................................ 36

LIMITATIONS........................................................................................................ 41

CONCLUSIONS...................................................................................................... 42

REFERENCES........................................................................................................ 43

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