Policy maker and health care provider perspectives on reproductive decision-making amongst HIV-infected individuals in South Africa.
BACKGROUND
Worldwide there is growing attention paid to the reproductive decisions faced by HIV-infected individuals. Studies in both developed and developing countries have suggested that many HIV-infected women continue to desire children despite knowledge of their HIV status. Despite the increasing attention to the health care needs of HIV-infected individuals in low resource settings, little attention has been given to reproductive choice and intentions. Health care providers play a crucial role in determining access to reproductive health services and their influence is likely to be heightened in delivering services to HIV-infected women. We examined the attitudes of health care policy makers and providers towards reproductive decision-making among HIV-infected individuals.


METHODS
In-depth interviews were conducted with 14 health care providers at two public sector health care facilities located in Cape Town, South Africa. In addition, 12 in-depth interviews with public sector policy makers and managers, and managers within HIV/AIDS and reproductive health NGOs were conducted. Data were analyzed using a grounded theory approach.


RESULTS
Providers and policy makers approached the issues related to being HIV-infected and child bearing differently. Biomedical considerations were paramount in providers' approaches to HIV infection and reproductive decision-making, whereas, policy makers approached the issues more broadly recognizing the structural constraints that inform the provision of reproductive health care services and the possibility of "choice" for HIV-infected individuals.


CONCLUSIONS
The findings highlight the diversity of perspectives among policy makers and providers regarding the reproductive decisions taken by HIV-infected people. There is a clear need for more explicit policies recognizing the reproductive rights and choices of HIV-infected individuals.
Harries
Jane
J
Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, Cape Town, South Africa. Jane.Harries@uct.ac.za
Cooper
Diane
D
Myer
Landon
L
Bracken
Hillary
H
Zweigenthal
Virginia
V
Orner
Phyllis
P
D000293:Adolescent; D000328:Adult; D003657:Decision Making; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D011050:Policy Making; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control; D034121:Reproductive Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D013019:South Africa; D016387:Women's Health