title: Provider attitudes about childbearing and knowledge of safer conception at two HIV clinics in Malawi.
abstract: BACKGROUND
  There is limited understanding of health care providers' attitudes towards HIV-infected individuals' reproductive choices, as well as knowledge about safer conception. Our study objective was to explore provider-level factors that serve as barriers and/or facilitators to the provision of reproductive and safer conception services for men and women living with HIV.
  
  
  METHODS
  Twenty-five providers were interviewed in four focus group discussions about their attitudes regarding childbearing by HIV-infected clients, reproductive health and HIV knowledge, and views and knowledge of safer conception.
  
  
  RESULTS
  Providers reported ambivalence about supporting childbearing among their clients with HIV. They raised concerns about HIV-infected individuals having children, and in certain cases expressed judgment that people with HIV should not have children because of these concerns. Providers lack specific knowledge about safer conception strategies and have low level of knowledge of reproductive health, the efficacy of PMTCT, and the risks of pregnancy for HIV-infected women.
  
  
  CONCLUSIONS
  Providers in our setting have complex attitudes about HIV-infected clients having children and lack knowledge to appropriately counsel clients about reproductive health and safer conception. Our findings highlight need for further research in this area as well as the need for provider training in reproductive health and safer conception.
authors.affiliation: Public Health Department, Nkhoma Hospital, Nkhoma, Malawi. paul.kawale@gmail.com.|, Private Bag 206, Lilongwe, Malawi. paul.kawale@gmail.com.
authors.forename: Paul
authors.initials: P
authors.lastname: Kawale
authors.affiliation: Center for Culture and Health, University of California, Los Angeles, CA, USA. dmindry@ucla.edu.
authors.forename: Deborah
authors.initials: D
authors.lastname: Mindry
authors.affiliation: Sector Wide Approach Secretariat, Ministry of Health, Lilongwe, Malawi. phoyaann@yahoo.com.
authors.forename: Ann
authors.initials: A
authors.lastname: Phoya
authors.affiliation: Partners In Hope Medical Center, Lilongwe, Malawi. director@pihmalawi.com.
authors.forename: Perry
authors.initials: P
authors.lastname: Jansen
authors.affiliation: David Geffen School of Medicine at the University of California, Los Angeles, Division of Infectious Diseases, Los Angeles, California, USA. RHoffman@mednet.ucla.edu.
authors.forename: Risa M
authors.initials: RM
authors.lastname: Hoffman
mesh_terms: D001291:Attitude of Health Personnel; D003267:Contraception / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000503:physiopathology / Q000523:psychology / Q000635:transmission*; D006679:HIV Seropositivity; D006282:Health Personnel / Q000523:psychology* / Q000592:standards; D006301:Health Services Needs and Demand; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008295:Malawi; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011369:Professional-Patient Relations; D036301:Qualitative Research; D060728:Reproductive Health; D021841:Safe Sex; D012731:Sex Counseling / Q000379:methods*; D012747:Sexual Partners / Q000523:psychology*