Hagey Jill M, Akama Eliud, Ayieko James, Bukusi Elizabeth A, Cohen Craig R, Patel Rena C
Medical Student, School of Medicine, University of California San Francisco, San Francisco, CA, USA;
Family AIDS Care & Education Services, Kisumu, Kenya.
J Int AIDS Soc. 2015 Sep 16;18(1):20123. doi: 10.7448/IAS.18.1.20123. eCollection 2015.
Avoiding unintended pregnancies is important for the health of adolescents living with HIV and has the additional benefit of preventing potential vertical HIV transmission. Health facility providers represent an untapped resource in understanding the barriers and facilitators adolescents living with HIV face when accessing contraception. By understanding these barriers and facilitators to contraceptive use among adolescent females living with HIV, this study aimed to understand how best to promote contraception within this marginalized population.
We conducted structured in-depth interviews with 40 providers at 21 Family AIDS Care & Education Services - supported clinics in Homabay, Kisumu and Migori counties in western Kenya from July to August 2014. Our interview guide explored the providers' perspectives on contraceptive service provision to adolescent females living with HIV with the following specific domains: contraception screening and counselling, service provision, commodity security and clinic structure. Transcripts from the interviews were analyzed using inductive content analysis.
According to providers, interpersonal factors dominated the barriers adolescent females living with HIV face in accessing contraception. Providers felt that adolescent females fear disclosing their sexual activity to parents, peers and providers, because of repercussions of perceived promiscuity. Furthermore, providers mentioned that adolescents find seeking contraceptive services without a male partner challenging, because some providers and community members view adolescents unaccompanied by their partners as not being serious about their relationships or having multiple concurrent relationships. On the other hand, providers noted that institutional factors best facilitated contraception for these adolescents. Integration of contraception and HIV care allows easier access to contraceptives by removing the stigma of coming to a clinic solely for contraceptive services. Youth-friendly services, including serving youth on days separate from adults, also create a more comfortable setting for adolescents seeking contraceptive services.
Providers at these facilities identified attitudes of equating seeking contraceptive services with promiscuity by parents, peers and providers as barriers preventing adolescent females living with HIV from accessing contraceptive services. Health facilities should provide services for adolescent females in a youth-friendly manner and integrate HIV and contraceptive services.
避免意外怀孕对于感染艾滋病毒的青少年的健康至关重要，还有助于预防潜在的垂直艾滋病毒传播。卫生机构提供者是了解感染艾滋病毒的青少年在获取避孕措施时所面临的障碍和促进因素的未开发资源。通过了解这些感染艾滋病毒的青春期女性使用避孕措施的障碍和促进因素，本研究旨在了解如何在这一边缘化人群中更好地推广避孕措施。
2014年7月至8月，我们在肯尼亚西部霍马湾、基苏木和米戈里县的21家由家庭艾滋病护理与教育服务机构支持的诊所，对40名提供者进行了结构化深入访谈。我们的访谈指南从以下特定领域探讨了提供者对为感染艾滋病毒的青春期女性提供避孕服务的看法：避孕筛查与咨询、服务提供、商品安全和诊所结构。访谈记录采用归纳性内容分析法进行分析。
据提供者称，人际因素在感染艾滋病毒的青春期女性获取避孕措施时面临的障碍中占主导地位。提供者认为，青春期女性担心向父母、同龄人及提供者透露自己的性活动，因为她们觉得这样可能会被视为滥交而受到影响。此外，提供者提到，青少年发现没有男性伴侣陪同寻求避孕服务具有挑战性，因为一些提供者和社区成员认为没有伴侣陪同的青少年对自己的关系不认真或有多个同时存在的关系。另一方面，提供者指出，机构因素最有助于这些青少年获得避孕措施。将避孕与艾滋病毒护理相结合，消除了只为避孕服务而来诊所的污名，使青少年更容易获得避孕药具。对青少年友好的服务，包括在与成人不同的日子为青少年服务，也为寻求避孕服务的青少年创造了更舒适的环境。
这些机构的提供者认为，父母、同龄人及提供者将寻求避孕服务等同于滥交的态度，是阻碍感染艾滋病毒的青春期女性获得避孕服务的障碍。卫生机构应以对青少年友好的方式为青春期女性提供服务，并将艾滋病毒和避孕服务相结合。
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