乌干达 HIV 血清不一致夫妇的更安全受孕咨询的益处和挑战。

Benefits and Challenges of Safer-Conception Counseling for HIV Serodiscordant Couples in Uganda.

机构信息

Center for Social Medicine and Humanities, Semel Institute, University of California, Los Angeles, CA, USA,

RAND Corporation, Santa Monica, CA, USA.

出版信息

Int Perspect Sex Reprod Health. 2018 Mar 1;44(1):31-39. doi: 10.1363/44e5718.

DOI:10.1363/44e5718

PMID:30028306

Abstract

CONTEXT

Safer-conception counseling may help people living with HIV to reduce the risk of transmission to partners and children. However, such counseling is rarely offered or evaluated in low-income countries.

METHODS

In 2014-2015, in-depth qualitative interviews were conducted at a Ugandan HIV clinic with 42 HIV-positive clients and 16 uninfected partners who had participated in a safer-conception counseling intervention for serodiscordant couples seeking to have a child. Participants attended up to six monthly counseling sessions in which they received instruction and ongoing support in using the safer-conception method they selected. Content analysis of interview transcripts was used to identify themes related to the benefits and challenges of safer-conception counseling.

RESULTS

Almost two-thirds of participants felt that safer-conception counseling was an empowering experience that enabled them to make informed choices regarding childbearing, learn how to conceive safely and understand how to stay healthy while trying to conceive. Timed unprotected intercourse was the most frequently used safer-conception method. Seven couples had successful pregnancies, and no uninfected partners seroconverted. Participants' primary concerns and challenges regarding counseling and method use were issues with manual self-insemination, difficulty with engaging partners and fear of HIV infection.

CONCLUSIONS

Counseling can help HIV-infected individuals make informed choices about childbearing and safer-conception methods; however, a controlled clinical trial is needed to determine whether clients use such methods correctly and to assess rates of pregnancy and transmission. Policymakers need to consider including safer-conception counseling as part of routine HIV care.

摘要

背景

安全受孕咨询可以帮助 HIV 感染者降低将病毒传染给伴侣和孩子的风险。然而，在低收入国家，这种咨询很少提供或评估。

方法

2014 年至 2015 年，在乌干达的一家 HIV 诊所，对 42 名 HIV 阳性的患者和 16 名未感染的伴侣进行了深入的定性访谈，这些伴侣参加了针对寻求生育的血清不一致夫妇的安全受孕咨询干预。参与者参加了多达六次的每月咨询会议，他们在会上接受了有关使用他们选择的更安全受孕方法的指导和持续支持。对访谈记录进行内容分析，以确定与安全受孕咨询的益处和挑战相关的主题。

结果

近三分之二的参与者认为安全受孕咨询是一种赋权体验，使他们能够就生育做出明智的选择，了解如何安全受孕，并了解在尝试受孕时如何保持健康。定时无保护性交是最常使用的更安全受孕方法。有 7 对夫妇成功怀孕，没有未感染的伴侣感染 HIV。参与者对咨询和方法使用的主要关注和挑战是手动自慰的问题，与伴侣的互动困难以及对 HIV 感染的恐惧。