title: "If I don't use a condom … I would be stressed in my heart that I've done something wrong": Routine Prevention Messages Preclude Safer Conception Counseling for HIV-Infected Men and Women in South Africa.
abstract: Intended conception likely contributes to a significant proportion of new HIV infections in South Africa. Safer conception strategies require healthcare provider-client communication about fertility intentions, periconception risks, and options to modify those risks. We conducted in-depth interviews with 35 HIV-infected men and women accessing care in South Africa to explore barriers and promoters to patient-provider communication around fertility desires and intentions. Few participants had discussed personal fertility goals with providers. Discussions about pregnancy focused on maternal and child health, not sexual HIV transmission; no participants had received tailored safer conception advice. Although participants welcomed safer conception counseling, barriers to client-initiated discussions included narrowly focused prevention messages and perceptions that periconception transmission risk is not modifiable. Supporting providers to assess clients' fertility intentions and offer appropriate advice, and public health campaigns that address sexual HIV transmission in the context of conception may improve awareness of and access to safer conception strategies.
authors.affiliation: Center for Global Health and Division of Infectious Disease, Massachusetts General Hospital, 100 Cambridge Street, 15th Floor, Boston, MA, 02114, USA, ltmatthews@partners.org.
authors.forename: L T
authors.initials: LT
authors.lastname: Matthews
authors.forename: L
authors.initials: L
authors.lastname: Moore
authors.forename: C
authors.initials: C
authors.lastname: Milford
authors.forename: R
authors.initials: R
authors.lastname: Greener
authors.forename: F N
authors.initials: FN
authors.lastname: Mosery
authors.forename: R
authors.initials: R
authors.lastname: Rifkin
authors.forename: C
authors.initials: C
authors.lastname: Psaros
authors.forename: S A
authors.initials: SA
authors.lastname: Safren
authors.forename: A
authors.initials: A
authors.lastname: Harrison
authors.forename: I B
authors.initials: IB
authors.lastname: Wilson
authors.forename: D R
authors.initials: DR
authors.lastname: Bangsberg
authors.forename: J A
authors.initials: JA
authors.lastname: Smit
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D003376:Counseling; D005260:Female; D005306:Fertilization; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D033182:Intention; D008297:Male; D009042:Motivation; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control; D011369:Professional-Patient Relations; D012747:Sexual Partners; D013019:South Africa