title: Reproductive counseling by clinic healthcare workers in Durban, South Africa: perspectives from HIV-infected men and women reporting serodiscordant partners.
abstract: BACKGROUND
  Understanding HIV-infected patient experiences and perceptions of reproductive counseling in the health care context is critical to inform design of effective pharmaco-behavioral interventions that minimize periconception HIV risk and support HIV-affected couples to realize their fertility goals.
  
  
  METHODS
  We conducted semistructured, in-depth interviews with 30 HIV-infected women (with pregnancy in prior year) and 20 HIV-infected men, all reporting serodiscordant partners and accessing care in Durban, South Africa. We investigated patient-reported experiences with safer conception counseling from health care workers (HCWs). Interview transcripts were reviewed and coded using content analysis for conceptual categories and emergent themes.
  
  
  RESULTS
  The study findings indicate that HIV-infected patients recognize HCWs as a resource for periconception-related information and are receptive to speaking to a HCW prior to becoming pregnant, but seldom seek or receive conception advice in the clinic setting. HIV nondisclosure and unplanned pregnancy are important intervening factors. When advice is shared, patients reported receiving a range of information. Male participants showed particular interest in accessing safer conception information.
  
  
  CONCLUSIONS
  HIV-infected men and women with serodiscordant partners are receptive to the idea of safer conception counseling. HCWs need to be supported to routinely initiate accurate safer conception counseling with HIV-infected patients of reproductive age.
authors.affiliation: Division of Infectious Disease and Center for Global Health, Massachusetts General Hospital, Boston, MA 02114, USA. ltmatthe@bidmc.harvard.edu
authors.forename: L T
authors.initials: LT
authors.lastname: Matthews
authors.forename: T
authors.initials: T
authors.lastname: Crankshaw
authors.forename: J
authors.initials: J
authors.lastname: Giddy
authors.forename: A
authors.initials: A
authors.lastname: Kaida
authors.forename: C
authors.initials: C
authors.lastname: Psaros
authors.forename: N C
authors.initials: NC
authors.lastname: Ware
authors.forename: J A
authors.initials: JA
authors.lastname: Smit
authors.forename: D R
authors.initials: DR
authors.lastname: Bangsberg
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D003267:Contraception / Q000523:psychology*; D003376:Counseling / Q000379:methods* / Q000592:standards; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006679:HIV Seropositivity; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control / Q000523:psychology*; D012747:Sexual Partners; D012959:Socioeconomic Factors; D013019:South Africa; D055815:Young Adult