title: Providers' perspectives on preconception counseling and safer conception for HIV-infected women.
abstract: BACKGROUND
  Unplanned pregnancy among HIV-infected women can have negative health consequences for women, partners, and neonates. Despite recommendations, preconception counseling (PCC) appears to be infrequently addressed in HIV care. This study explored knowledge, attitudes, and practices among health-care providers regarding PCC, safer conception and pregnancy among HIV-infected women.
  
  
  METHODS
  Physicians, physician assistants, and nurse practitioners (n = 14) providing obstetric/gynecological and HIV care in urban south Florida public and private hospitals completed structured qualitative interviews. Dominant themes arising included provider perceptions of patient knowledge and practices, provider knowledge and attitudes regarding safer conception, and provider practices regarding reproductive health.
  
  
  RESULTS
  Providers perceived patients to have limited reproductive knowledge. Patients' internalized HIV stigma was a barrier to patient initiation of conception-focused discussions. Provider knowledge and utilization of PCC protocols were limited. PCC barriers included competing medical priorities, failure to address fertility desires, limited knowledge, time limitations, and unclear standard of care. Providers routinely used condom-based HIV prevention as a proxy for addressing reproductive intentions.
  
  
  CONCLUSIONS
  Provider, patient, and structural factors prevented implementation of PCC and provision of information on safer conception; neither were routinely discussed during consultations. Both providers and patients may benefit from interventions to enhance communication on conception.
authors.affiliation: a Department of Psychiatry & Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA.
authors.forename: Alison S
authors.initials: AS
authors.lastname: Coll
authors.affiliation: b Department of Obstetrics & Gynecology , University of Miami Miller School of Medicine , Miami , FL , USA.
authors.forename: JoNell E
authors.initials: JE
authors.lastname: Potter
authors.affiliation: b Department of Obstetrics & Gynecology , University of Miami Miller School of Medicine , Miami , FL , USA.
authors.forename: Nahida
authors.initials: N
authors.lastname: Chakhtoura
authors.affiliation: b Department of Obstetrics & Gynecology , University of Miami Miller School of Medicine , Miami , FL , USA.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Alcaide
authors.affiliation: a Department of Psychiatry & Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Cook
authors.affiliation: a Department of Psychiatry & Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA.
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Jones
mesh_terms: D001291:Attitude of Health Personnel; D017280:Condoms / Q000706:statistics & numerical data; D003267:Contraception / Q000523:psychology*; D003376:Counseling / Q000379:methods*; D005260:Female; D005306:Fertilization; D005431:Florida; D015658:HIV Infections / Q000503:physiopathology / Q000523:psychology / Q000635:transmission*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D033182:Intention; D007407:Interviews as Topic; D008297:Male; D010465:Perception; D016742:Preconception Care / Q000379:methods*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D036301:Qualitative Research; D060728:Reproductive Health; D012747:Sexual Partners / Q000523:psychology
keywords: HIV; Preconception counseling; qualitative; safer conception methods; unplanned pregnancy