Table 2.
Contraceptive preferences and childbearing decisions among PLHIV
| Theme | Adolescents | Adult men and women |
|---|---|---|
| Preferred contraceptive methods |
· Largely condoms: easy to use, accessible and do not affect their fertility |
· Condoms most preferred: easy to use, cheap and easy to access; limited side effects; prevent pregnancy and HIV transmission (men who fear to disclose their HIV status can use them under the pretext of FP) |
| · Some preferred to abstain |
· Some women liked injectables, implants: no challenges with remembering to take pills daily, do not like to use or cannot tell partners to use condoms (limit sexual pleasure); can use without telling their partners or asking their permission |
|
| · Fear pills, injectables and other long-term methods because they can prevent them from having children in future |
|
|
| Challenges/experiences with contraceptives |
· Education on FP is limited; providers focusing more on adults |
· Intrauterine devices and implants were not easily accessible and were expensive |
| · Challenges with accessing FP information; not aware of options and side-effects |
· Injectables available but expensive |
|
| · Fear to ask providers for information if providers do not initiate discussion |
· Limited education on some methods (e.g. Intrauterine devices; implants) |
|
| |
· Pills: concerns about pill burden and remembering to take them |
|
| · Side effects with pills and injectables noted by both men and women: abdominal complications, prolonged periods, infertility and child abnormalities; weight problems, high blood pressure, heart palpitations, and sleeplessness | ||
| · Mixed feelings about vasectomy among men | ||
| · Men felt providers focused more on women | ||
| · Providers focused more on PLHIV who had initiated ART | ||
| Challenges with accessing contraceptives at the clinics and other facilities |
· Cost of the contraceptives high |
· Mulago: busy clinic and long waiting time (separate desk/provider for FP) |
| · NHC: some of the PLHIV do not go to the facilities where they are referred for contraceptives; challenges disclosing their HIV status to another set of providers; ‘Moon beads’/rhythm method that is talked about at the clinic unreliable | ||
| Decisions to have children |
· All want to have children; at least one/feared dying without children |
· All want to have children; feel it is not good to have one child/unfair to the child |
| · Considerations: have few children or none/cultural expectations to have large families; have only boys or only girls; male child to have an heir; getting into a new sexual relationship/to strengthen relationship; pressures from family members and community (to be accepted); HIV status of the sexual partner; ability to care for more children | ||
| Decision not to have children |
· Health status (transient issue) |
· Sero-discordance/concerns about infecting sexual partner |
| · Already have several children | ||
| · Health status (transient issue) | ||
| Information and support given by providers on childbearing: client perspectives |
· Same issues as adults |
· Focusing more on contraceptives |
| · Not enough attention to child spacing and number of children they want to have | ||
| · Not addressing fertility decisions and support for those who want to have children | ||
| Attitude and support from HCWs in relation to childbearing: Client perspectives |
· Desired to have more guidance on childbearing |
· Providers talk about PMTCT services |
| · Counselors were supportive and asked them to be open up about their plans to marry and have children |
· Health status: providers emphasized need to have high CD4 count; adherent to ART |
|
| |
· Noted gaps in information for those who want to have children/told to use condoms all the time and not clear how they can conceive |
|
| · Mulago: all participants felt providers were supportive | ||
| · NHC: divided about support from providers (some felt providers had negative attitude towards childbearing among PLHIV) | ||
| Health workers’ voices | · Need to expand SRH services to include cervical cancer screening |
|
| · Support for PLHIV who want to have children not comprehensive enough and needs improvement | ||
| · NHC providers noted gap with not providing FP supplies: suggested formal referral mechanism since their policy does not allow contraceptives on site | ||
| · All felt PLHIV had a right to have children and needed support: need to be clinically stable and have a high CD4 count; should be on ART; should use PMTCT services | ||
| · More sympathetic to those who have no children (e.g. adolescents); those who have children should not get more |