Patient-provider communication and reproductive health among HIV-positive women in Rio de Janeiro, Brazil.
OBJECTIVE
To qualitatively assess the influence of patient-provider communication on contraceptive choice among HIV-positive women in the context of universal antiretroviral therapy (ART) access.


METHODS
Focus group discussions (FGD; n=3), in-depth (IDI; n=15) and freelist interviews (FLI; n=36) were conducted with HIV-positive women aged 18-40 years recruited from public health units in Rio de Janeiro/Brazil.


RESULTS
Of 70 participants, 49 used ART and the median time since HIV diagnosis was 6 years (range: 1-18). The majority of participants (71.4%) reported some degree of dissatisfaction with their health providers (usually lack of open dialogue) and a few reported experiences of stigma/prejudice during appointments. Intra, interpersonal and social factors modulated behaviors and reproductive health decisions, and those issues were rarely addressed by providers during HIV clinical care.


CONCLUSIONS
Despite dramatic increases in survival and life quality after universal ART implementation in Brazil, reproductive health issues are neglected by multiple cadres of HIV health providers. Communication on reproductive health issues remains fragmented and potentially contradictory, compromising care in these settings.


CONCLUSIONS
Adequate provider training to address reproductive health-related issues in a comprehensive, culturally sensitive manner and improved integration of HIV and reproductive health care are urgently needed in this setting.
Oswaldo Cruz Foundation, Social Science Department, National School of Public Health (DCS/ENSP), Rio de Janeiro, Brazil. malta@ensp.fiocruz.br
Monica
M
Malta
Catherine S
CS
Todd
Mark A
MA
Stibich
Thais
T
Garcia
Diego
D
Pacheco
Francisco I
FI
Bastos
D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001938:Brazil; D002755:Choice Behavior; D003142:Communication; D003268:Contraception Behavior; D003270:Contraceptive Agents / Q000008:administration & dosage; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006679:HIV Seropositivity / Q000188:drug therapy / Q000821:virology; D006801:Humans; D007407:Interviews as Topic; D011369:Professional-Patient Relations; D036301:Qualitative Research; D034121:Reproductive Health Services / Q000706:statistics & numerical data; D055815:Young Adult
D044966:Anti-Retroviral Agents; D003270:Contraceptive Agents