title: "I Always Worry about What Might Happen Ahead": Implementing Safer Conception Services in the Current Environment of Reproductive Counseling for HIV-Affected Men and Women in Uganda.
abstract: BACKGROUND
  We explored healthcare provider perspectives and practices regarding safer conception counseling for HIV-affected clients.
  
  
  METHODS
  We conducted semistructured interviews with 38 providers (medical and clinical officers, nurses, peer counselors, and village health workers) delivering care to HIV-infected clients across 5 healthcare centres in Mbarara District, Uganda. Interview transcripts were analyzed using content analysis.
  
  
  RESULTS
  Of 38 providers, 76% were women with median age 34 years (range 24-57). First, we discuss providers' reproductive counseling practices. Emergent themes include that providers (1) assess reproductive goals of HIV-infected female clients frequently, but infrequently for male clients; (2) offer counseling focused on "family planning" and maternal and child health; (3) empathize with the importance of having children for HIV-affected clients; and (4) describe opportunities to counsel HIV-serodiscordant couples. Second, we discuss provider-level challenges that impede safer conception counseling. Emergent themes included the following: (1) providers struggle to translate reproductive rights language into individualized risk reduction given concerns about maternal health and HIV transmission and (2) providers lack safer conception training and support needed to provide counseling.
  
  
  CONCLUSIONS
  Tailored guidelines and training are required for providers to implement safer conception counseling. Such support must respond to provider experiences with adverse HIV-related maternal and child outcomes and a national emphasis on pregnancy prevention.
authors.affiliation: Massachusetts General Hospital, Center for Global Health and Division of Infectious Disease, Boston, MA 02114, USA.
authors.forename: Lynn T
authors.identifier: 0000-0001-6167-6328
authors.initials: LT
authors.lastname: Matthews
authors.affiliation: Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Francis
authors.initials: F
authors.lastname: Bajunirwe
authors.affiliation: McGill University Research Centre, Montreal, QC, Canada H3H 2R9.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Kastner
authors.affiliation: Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Naomi
authors.initials: N
authors.lastname: Sanyu
authors.affiliation: Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Akatukwasa
authors.affiliation: Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
authors.forename: Courtney
authors.initials: C
authors.lastname: Ng
authors.affiliation: Massachusetts General Hospital, Center for Global Health, Boston, MA 02114, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Rifkin
authors.affiliation: University of the Witwatersrand, Maternal, Adolescent, and Child Health (MatCH) Research, Durban, KwaZulu-Natal 3629, South Africa.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Milford
authors.affiliation: University of the Witwatersrand, Maternal, Adolescent, and Child Health (MatCH) Research, Durban, KwaZulu-Natal 3629, South Africa.
authors.forename: Lizzie
authors.initials: L
authors.lastname: Moore
authors.affiliation: Brown University School of Public Health, Providence, RI 02903, USA.
authors.forename: Ira B
authors.initials: IB
authors.lastname: Wilson
authors.affiliation: Massachusetts General Hospital, Center for Global Health, Boston, MA 02114, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
authors.affiliation: University of the Witwatersrand, Maternal, Adolescent, and Child Health (MatCH) Research, Durban, KwaZulu-Natal 3629, South Africa.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Smit
authors.affiliation: Simon Fraser University, Burnaby, BC, Canada V5A 1S6.
authors.forename: Angela
authors.initials: A
authors.lastname: Kaida
mesh_terms: D000328:Adult; D003376:Counseling / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D034121:Reproductive Health Services / Q000706:statistics & numerical data*; D014454:Uganda; D055815:Young Adult