Table 1.
Providers’ responses to the selected survey items and scales (completers only).
| Baseline (N=35) | 12 months (N=33) | 24 months (N=35) | Wilcoxon p value | ||||
|---|---|---|---|---|---|---|---|
| Survey Items | M (SD; range) | % Yes or Agree a | M (SD; range) | % Yes or Agree a | M (SD; range) | % Yes or Agree a | (0–24 mo change) |
| Provider Stigma of Childbearing Among PLHIV scale (1= strongly disagree to 4 = strongly agree; ∝ = .63) | 2.1 (0.5; 1.4–3.2) | 1.8 (0.4; 1.2–2.6) | 2.1 (0.4; 1.0–2.8) | .964 | |||
| Children born to an HIV+ parent face more challenges than are necessary. | 2.8 (0.8; 1.0–4.0) | 66% | 2.4 (0.8; 1.0–4.0) | 48% | 2.5 (0.7; 1.0–4.0) | 54% | |
| HIV+ people often lack all that they need to bring a child into the world. | 2.2 (1.0; 1.0–4.0) | 31% | 1.8 (0.7; 1.0–3.0) | 18% | 2.0 (0.8; 1.0–3.0) | 31% | |
| HIV+ people who want to have children are being selfish. | 1.8 (0.9; 1.0–4.0) | 23% | 1.5 (0.7; 1.0–3.0) | 9% | 2.0 (0.9; 1.0–3.0) | 37% | |
| Helping HIV+ people have children is a distraction from more important issues that we need to address as providers. | 1.2 (0.4; 1.0–2.0) | 0% | 1.2 (0.4; 1.0–2.0) | 0% | 1.3 (0.4; 1.0–2.0) | 0% | |
| Ensuring patients are always having safe protected sex is more important than helping HIV+ people to have children. | 2.6 (0.8; 1.0–4.0) | 54% | 2.2 (0.8; 1.0–4.0) | 36% | 2.9 (0.7; 1.0–4.0) | 74% | |
| Awareness of SCM (0 = No, 1 = Yes, 3 = Not Sure) | 4.3 (1.3; 2.0–7.0) | 6.7 (1.3; 3.0–9.0) | 7.3 (1.9; 0.0–9.0) | <.001 | |||
| 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? |
91% | 97% | 94% | ||||
| ...by having them engage in unprotected or live sex only during the few days of the month when the woman is most fertile? | 69% | 100% | 100% | ||||
| ...whereby the man ejaculates into a container or condom and then the semen is injected into the woman’s vagina? | 49% | 67% | 72% | ||||
| 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? | 23% | 27% | 15% | ||||
| 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? | 63% | 64% | 88% | ||||
| 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? | 43% | 55% | 79% | ||||
| 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? | 94% | 88% | 97% | ||||
| Perceived Value of Providing SCC scale (1= strongly disagree to 4 = strongly agree; ∝ = .74) | 1.9 (0.7; 1.0–3.7) | 1.6 (0.5; 1.0–3.0) | 1.5 (0.5; 1.0–3.0) | <.001 | |||
| 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. |
1.5 (0.8; 1.0–3.0) | 17% | 1.2 (0.6; 1.0–3.0) | 9% | 1.1 (0.3; 1.0–2.0) | 0% | |
| ...to a female client is a waste of time as their man will demand live sex. | 1.7 (0.9; 1.0–4.0) | 20% | 1.4 (0.6; 1.0–3.0) | 6% | 1.4 (0.7; 1.0–4.0) | 9% | |
| 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. | 2.5 (0.9; 1.0–4.0) | 57% | 2.2 (0.8; 1.0–4.0) | 39% | 2.1 (0.8; 1.0–4.0) | 24% | |
| 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% | 94% | 97% | ||||
| 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? | 66% | 78% | 71% | ||||
| Will couples be willing to have unprotected or “live” sex only during the few days a month when the woman is most fertile? | 91% | 82% | 94% | ||||
| 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% | 79% | 71% | ||||
| 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. | 97% | 94% | 100% | ||||
| 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. | 83% | 85% | 94% | ||||
| Barriers to Providing SCC (1= Not a barrier at all, 2 = somewhat a barrier, 3 = definitely a barrier) | 2.2 (0.5; 1.2–2.8) | 2.3 (0.4; 1.3–2.8) | 2.1 (0.4; 1.2–2.7) | .006 | |||
| How much of a barrier is... ...poor access to male members of couples who want to have a child. |
94% | 97% | 82% | ||||
| ...lack of HIV disclosure within couples who want to have a child. | 94% | 100% | 76% | ||||
| ...no established guidelines or recommendations for how to provide such counseling. | 86% | 85% | 91% | ||||
| ...not having any educational tools to use in counseling clients. | 86% | 85% | 79% | ||||
| ...poor access to ARVs that can be taken by uninfected partners during periods of unprotected sex when trying to conceive? | 86% | 94% | 85% | ||||
| ...lack of training for how to provide such counseling. | 80% | 91% | 88% | ||||
| ...client reluctance to discuss childbearing needs. | 83% | 85% | 85% | ||||
| ...lack of resources and support from the clinic administration for such counseling. | 66% | 64% | 35% | ||||
| ...poor access to ART for patients who want to have a child but their CD4 is not low enough to quality for ART. | 74% | 61% | 71% | ||||
| ...not having enough time to talk further with clients. | 66% | 85% | 71% | ||||
| ...my personal reluctance to discus with client their desires to have children. | 66% | 76% | 76% | ||||
| 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? |
94% | 97% | 97% | ||||
| ...discuss the availability and use of methods to increase the safety of conception with HIV clients who have a desire to have children. | 94% | 100% | 100% | ||||
| Interest in Providing SCC scales b (1= low interest to 10= high interest or 1= strongly disagree to 4 = strongly agree; ∝ = .79) | ∝=.81 | ∝=.66 | ∝=.64 | ||||
| Interest in Providing SCC to Serodiscordant Couples scale (∝ = .91) | 8.7 (1.8; 3.0–10.0) | 8.6 (1.6; 5.0–10.0) | 8.2 (1.1; 5.5–10.0) | .059 | |||
| 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? |
8.7 (1.9; 3.0–10.0) | 8.6 (1.6; 5.0–10.0) | 8.1 (1.3; 5.0–10.0) | ||||
| ...on how to conceive safely to a couple where the man is HIV+ and the woman is not? | 8.7 (1.9; 3.0–10.0) | 8.7 (1.7; 5.0–10.0) | 8.3 (1.1; 6.0–10.0) | ||||
| Interest in Providing SCC Regarding Specific SCM scale c (∝ =.72; ∝ for first three items = .61) | 7.6 (1.7; 3.5–9.5) | 7.9 (1.3; 4.7–10.0) | 7.9 (1.0; 5.3–9.5) | .920 | |||
| 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? |
7.0 (3.0; 1.0–10.0) | 7.3 (2.0; 2.0–10.0) | 7.4 (1.7; 3.0–10.0) | ||||
| ...(where the woman is HIV+) about how to collect the man’s semen and inject it into the woman’s vagina? | 7.6 (3.0; 1.0–10.0) | 8.3 (2.3; 3.0–10.0) | 6.8 (2.0; 1.0–10.0) | ||||
| 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? | 9.2 (1.9; 1.0–10.0) | 9.7 (0.7; 8.0–10.0) | 8.3 (1.6; 5.0–10.0) | ||||
| Most clients will not follow the advice we give regarding how to increase the safety of conception. | 1.9 (0.8; 1.0–3.0) | 26% | 2.0 (0.8; 1.0–4.0) | 21% | 1.5 (0.7; 1.0–4.0) | 3% | |
| Most uninfected partners will not take HIV medications daily during the conception period. | 2.1 (0.9; 1.0–4.0) | 29% | 2.2 (0.8; 1.0–4.0) | 27% | 1.9 (0.7; 1.0–4.0) | 15% | |
| It is not a good use of resources to recommend that uninfected partners take HIV medications daily during the conception period. | 1.6 (0.8; 1.0–4.0) | 17% | 1.5 (0.8; 1.0–4.0) | 15% | 1.4 (0.8; 1.0–4.0) | 15% | |
| Interest in Providing SCC in the Context of Relational Factors scale (∝ = .83) | 8.0 (2.4; 1.8–10.0) | 8.3 (1.8; 3.0–10.0) | 8.1 (1.6; 1.0–10.0) | .774 | |||
| 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 (3.0; 1.0–10.0) | 8.1 (2.4; 2.0–10.0) | 8.0 (1.8; 1.0–10.0) | ||||
| ...to an HIV-infected man who wants to conceive, but does not have a committed partner? | 7.7 (2.9; 1.0–10.0) | 8.1 (2.3; 2.0–10.0) | 8.0 (1.8; 1.0–10.0) | ||||
| ...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? | 8.7 (2.6; 1.0–10.0) | 8.9 (1.5; 5.0–10.0) | 8.5 (1.8; 1.0–10.0) | ||||
| ...to HIV-affected couples who want to conceive if they already have children? | 8.0 (2.9; 1.0–10.0) | 8.1 (2.7; 2.0–10.0) | 8.0 (2.4; 1.0–10.0) | ||||
| Self-efficacy for Providing SCC scale (1= not at all to 10= extremely; ∝ = .87) | 7.4 (1.6; 4.0–9.9) | 7.6 (1.4; 5.0–9.9) | 8.0 (0.8; 6.9–10.0) | .022 | |||
| How confident do you feel in your ability to ...ask clients about their future childbearing goals? |
8.1 (2.0; 4.0–10.0) | 7.8 (1.7; 5.0–10.0) | 8.1 (1.2; 5.0–10.0) | ||||
| ...provide safer conception guidance to a couple in which the woman is HIV-infected and the man is not? | 6.9 (2.5; 3.0–10.0) | 6.9 (2.1; 3.0–10.0) | 7.6 (1.4; 4.0–10.0) | ||||
| ...provide safer conception guidance to a couple in which the man is HIV-infected and the woman is not? | 6.7 (2.3; 3.0–10.0) | 7.1 (2.1; 2.0–10.0) | 7.8 (1.2; 5.0–10.0) | ||||
| ...provide guidance to an HIV-infected woman who wants to conceive, but does not have a committed partner? | 6.8 (2.4; 1.0–10.0) | 7.5 (2.0; 2.0–10.0) | 7.8 (1.3; 5.0–10.0) | ||||
| ...provide guidance to an HIV-infected man who wants to have a child, but does not have a committed partner? | 6.8 (2.3; 1.0–10.0) | 7.4 (2.1; 1.0–10.0) | 7.9 (1.4; 5.0–10.0) | ||||
| ...provide guidance about disclosure to HIV+ client who wants a child with HIV-negative partner, to whom they have not disclosed? | 7.3 (2.2; 1.0–10.0) | 7.2 (2.4; 1.0–10.0) | 8.2 (1.2; 6.0–10.0) | ||||
| 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? | 8.3 (2.0; 2.0–10.0) | 9.1 (1.2; 6.0–10.0) | 8.3 (1.3; 6.0–10.0) | ||||
| 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 (1.8; 5.0–10.0) | 8.2 (1.7; 5.0–10.0) | 8.2 (1.4; 4.0–10.0) | ||||
| 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 (1.6; 5.0–10.0) | 8.1 (1.5; 5.0–10.0) | 8.4 (1.4; 5.0–10.0) | ||||
| ...female clients any desires or plans they may have regarding having children? | 8.8 (1.4; 5.0–10.0) | 8.8 (1.2; 6.0–10.0) | 8.6 (1.1; 7.0–10.0) | ||||
| ...patients who have a desire to have children, the availability and use of methods to increase the safety of conception? | 9.5 (1.2; 4.0–10.0) | 9.3 (1.2; 5.0–10.0) | 9.1 (1.0; 7.0–10.0) | ||||
| ...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? | 7.0 (2.7; 1.0–10.0) | 7.2 (2.0; 2.0–10.0) | 7.4 (1.5; 4.0–10.0) | ||||
| ...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? | 7.7 (3.2; 1.0–10.0) | 7.9 (2.9; 1.0–10.0) | 6.2 (1.8; 2.0–10.0) |
a
Reported percent is the combined percent of “Agree/Strongly Agree” or “somewhat/definitely” responses.
b
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.
c
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.