Table 1.
Providers' Responses to Selected Survey Items and Scales
| Survey items | M (SD; range) | % Yes or agree |
|---|---|---|
| Provider Stigma of Childbearing among PLHA Scale (1 = strongly disagree to 4 = strongly agree; ∝ = 0.87) | 2.0 (0.5; 1.2–3.2) | |
| Children born to an HIV+ parent face more challenges than are necessary. | 2.8 (0.9; 1–4) | 63% |
| HIV+ people often lack all that they need to bring a child into the world. | 2.1 (1.0; 1–4) | 30% |
| HIV+ people who want to have children are being selfish. | 1.6 (0.8; 1–4) | 16% |
| Helping HIV+ people have children is a distraction from more important issues that we need to address as providers. | 1.2 (0.5; 1–3) | 2% |
| Ensuring patients are always having safe protected sex is more important than helping HIV+ people to have children. | 2.5 (0.8; 1–4) | 44% |
| Awareness of SCM (0 = no, 1 = yes, 3 = not sure) | 4.2 (1.3; 1–7) | |
| Are you aware of methods to increase the safety of conception in mixed status couples… | ||
| …(sero-discordant) couples where one partner is HIV+ and the other is HIV-negative? | 86% | |
| …by having them engage in unprotected or live sex only during the few days of the month when the woman is most fertile? | 75% | |
| …whereby the man ejaculates into a container or condom and then the semen is injected into the woman's vagina? | 51% | |
| To the best of your knowledge, have guidelines from any organization been established yet to guide providers in addressing the comprehensive reproductive needs of HIV+ individuals and couples who want to have children? | 30% | |
| Are you aware of technology that removes HIV from the man's semen and thus increase the safety of conception in couples where man is HIV+ and woman negative? | 53% | |
| Do you know where to refer a client or couple who want to use any of the methods described above to make conception more safe? | 37% | |
| HIV medication that can be taken by a HIV-negative partner who wants to conceive with a HIV+ partner to reduce his/her risk of infection? | 84% | |
| Perceived Value of Providing SCC Scale (1 = strongly disagree to 4 = strongly agree; ∝ = 0.73) | 1.8 (0.7; 1–3.7) | |
| Providing guidance on safer conception… | ||
| …to a female client is a waste of time as they won't be able to get their man to agree to modify their sexual practices. | 1.4 (0.7; 1–3) | 12% |
| …to a female client is a waste of time as their man will demand live sex. | 1.7 (0.9; 1–4) | 21% |
| Clients who are counseled to have unprotected or “live” sex during a few days a month when the woman is most fertile will not want to resume using condoms afterward. | 2.4 (0.9; 1–4) | 49% |
| Perceived Acceptability of SCM to Clients (1 = strongly disagree to 4 = strongly agree) | ||
| Will clients be okay with being asked to make a conception plan with a health care provider? | 91% | |
| Will couples be willing to collect the man's semen [perhaps by having sex with a condom] and inject it into the woman's vagina? | 61% | |
| Will couples be willing to have unprotected or “live” sex only during the few days a month when the woman is most fertile? | 93% | |
| Will couples be willing to have the man's sperm washed to remove HIV with the use of technology, and then inserted into the woman's vagina if cost was not a factor? | 82% | |
| Will HIV+ partners would be willing to start HIV medication early if they knew it would reduce their risk of transmitting the virus to a partner. | 98% | |
| Will HIV negative partners of HIV+ patients would be willing to take HIV medication every day during the months in which they were trying to conceive in order to reduce their risk of infection. | 79% | |
| Barriers to Providing SCC (1 = Not at all, 2 = somewhat, 3 = definitely a barrier) | 2.3 (0.4, 1.2–2.8) | |
| How much of a barrier is… | ||
| …poor access to male members of couples who want to have a child. | 96% | |
| …lack of HIV disclosure within couples who want to have a child. | 91% | |
| …no established guidelines or recommendations for how to provide such counseling. | 89% | |
| …not having any educational tools to use in counseling clients. | 88% | |
| …poor access to ARVs that can be taken by uninfected partners during periods of unprotected sex when trying to conceive? | 86% | |
| …lack of training for how to provide such counseling. | 84% | |
| …client reluctance to discuss childbearing needs. | 81% | |
| …lack of resources and support from the clinic administration for such counseling. | 75% | |
| …poor access to ART for patients who want to have a child but their CD4 is not low enough to quality for ART. | 75% | |
| …not having enough time to talk further with clients. | 67% | |
| …my personal reluctance to discus with client their desires to have children. | 65% | |
| Peer Support for Providing SCC (1 = strongly disagree to 4 = strongly agree) | ||
| People I know and respect think I should… | ||
| …talk to HIV patients about their desires to have children? | 95% | |
| …discuss the availability and use of methods to increase the safety of conception with HIV clients who have a desire to have children. | 93% | |
| Interest in Providing SCC Scales (1 = low interest to 10 = high interest or 1 = strongly disagree to 4 = strongly agree; ∝ = 0.73) | ||
| Interest in Providing SCC to Serodiscordant Couples Scale (∝ = 0.91) | 9.0 (1.6; 3–10) | |
| How interested are you in providing guidance… | ||
| …on how to conceive safely to a couple where the woman is HIV+ and the man is not? | 9.0 (1.6; 3–10) | |
| …on how to conceive safely to a couple where the man is HIV+ and the woman is not? | 9.0 (1.7; 3–10) | |
| Interest in Providing SCC Regarding Specific SCM Scale (∝ = 0.68; ∝ for first three items = 0.61) | 7.5 (1.6; 3.5–9.7) | |
| How interested are you in providing guidance to mixed status couples… | ||
| …about the use of unprotected or “live” sex only during the few days a month when the woman is most fertile? | 7.5 (2.7; 1–10) | |
| …(where the woman is HIV+) about how to collect the man's semen and inject it into the woman's vagina? | 7.5 (3.1; 1–10) | |
| If ARVs were approved for such use in Uganda, how interested would you be in providing guidance to uninfected partners of your HIV+ patients about taking ARVs daily during the months they attempt conception via unprotected sex? | 9.3 (1.6; 1–10) | |
| Most clients will not follow the advice we give regarding how to increase the safety of conception. | 2.0 (0.8; 1–4) | 27% |
| Most uninfected partners will not take HIV medications daily during the conception period. | 2.3 (0.9; 1–4) | 39% |
| It is not a good use of resources to recommend that uninfected partners take HIV medications daily during the conception period. | 1.8 (0.8; 1–4) | 18% |
| Interest in Providing SCC in the Context of Relational Factors Scale (∝ = 0.83) | 8.0 (2.3; 1.8–10) | |
| How interested are you in providing guidance… | ||
| …to an HIV-infected woman who wants to conceive, but does not have a committed partner? | 7.9 (2.8; 1–10) | |
| …to an HIV-infected man who wants to conceive, but does not have a committed partner? | 7.7 (2.9; 1–10) | |
| …about HIV disclosure to HIV-infected client who wants a child with an HIV-negative partner, to whom they have not disclosed their HIV status? | 8.6 (2.7; 1–10) | |
| …to HIV-affected couples who want to conceive if they already have children? | 7.9 (2.9; 1–10) | |
| Self-Efficacy for Providing SCC Scale (1 = not at all to 10 = extremely; ∝ = 0.87) | 7.6 (1.6; 4–9.9) | |
| How confident do you feel in your ability to | ||
| …ask clients about their future childbearing goals? | 8.3 (2.1; 4–10) | |
| …provide safer conception guidance to a couple in which the woman is HIV-infected and the man is not? | 7.3 (2.3; 3–10) | |
| …provide safer conception guidance to a couple in which the man is HIV-infected and the woman is not? | 7.0 (2.2; 3–10) | |
| …provide guidance to an HIV-infected woman who wants to conceive, but does not have a committed partner? | 6.9 (2.4; 1–10) | |
| …provide guidance to an HIV-infected man who wants to have a child, but does not have a committed partner? | 6.9 (2.3; 1–10) | |
| …provide guidance about disclosure to HIV+ client who wants a child with HIV-negative partner, to whom they have not disclosed? | 7.5 (2.2; 1–10) | |
| If ART initiation was not restricted by CD4 count, how confident are you that you could provide guidance for early initiation of ART among HIV+ patients with uninfected partners who want to conceive? | 8.4 (2.0; 2–10) | |
| If pre-exposure prophylaxis was readily available in Uganda, how confident are you that you could provide guidance to uninfected partners of your HIV+ patients on taking ARVs daily during the months they attempted conception via unprotected sex? | 8.2 (1.9; 4–10) | |
| Intentions to Provide SCC (1 = low intention to 10 = high intention) | ||
| How much do you intend to discuss/talk with… | ||
| …male clients any desires or plans they may have regarding having children? | 8.3 (1.5; 5–10) | |
| …female clients any desires or plans they may have regarding having children? | 8.8 (1.5; 5–10) | |
| …patients who have a desire to have children, the availability and use of methods to increase the safety of conception? | 9.5 (1.2; 4–10) | |
| …mixed status couples who want to have a child about the use of timed unprotected intercourse- i.e., having “live” sex only during the few days a month when the woman is most fertile? | 7.4 (2.4; 1–10) | |
| …mixed status [woman is HIV+] who want to have a child about how to collect the man's semen and inject it into the woman's vagina? | 7.5 (3.0; 1–10) | |
Reported percent is the combined percent of “Agree/Strongly Agree” or “somewhat/definitely” responses. Interest in Providing SCC Regarding Specific SCM scale scores were computed by converting the three reverse-coded 4-point Likert items to a 10-point scale before averaging across the six items. The Interest in providing SCC for specific SCM scale included both 4- and 10-point Likert-type items; we converted responses on the 4-point items to a 10-point scale (1 = 1, 2 = 4, 3 = 7, 4 = 10) before averaging across the six items.