Feyissa Tesfaye Regassa, Harris Melissa L, Loxton Deborah
College of Health Science, Wollega University, Nekemte, Oromia, Ethiopia.
Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
Reprod Health. 2020 Aug 17;17(1):124. doi: 10.1186/s12978-020-00971-2.
Despite the importance of women living with HIV (WLHIV) engaging in fertility plan discussions with their healthcare providers (HCPs), little research exists. This study explored perceptions surrounding fertility plan discussions between WLHIV and their HCPs in western Ethiopia, from the perspectives of both women and providers.
Thirty-one interviews (27 with WLHIV and 4 with HCPs) were conducted at four healthcare facilities in western Ethiopia in 2018. Data were transcribed verbatim and translated into English. Codes and themes were identified using inductive thematic analysis.
There was a discordance between HCPs and WLHIV's perception regarding the delivery of fertility plan discussions. Only nine of the 27 WLHIV reported they had discussed their personal fertility plans with their HCPs. When discussions did occur, safer conception and contraceptive use were the primary focus. Referrals to mother support groups, adherence counsellors as well as family planning clinics (where they can access reproductive counselling) facilitated fertility discussions. However, lack of initiating discussions by either HCPs or women, high client load and insufficient staffing, and a poor referral system were barriers to discussing fertility plans. Where discussions did occur, barriers to good quality interactions were: (a) lack of recognizing women's fertility needs; (b) a lack of time and being overworked; (c) mismatched fertility desire among couples; (d) non-disclosure of HIV-positive status to a partner; (e) poor partner involvement; (f) fear of repercussions of disclosing fertility desires to a HCP; and (g) HCPs fear of seroconversion.
Our findings highlight the need for policies and guidelines to support fertility plan discussions. Training of HCPs, provision of non-judgmental and client-centered fertility counselling, improving integration of services along with increased human resources are crucial to counselling provision. Enhancing partner involvement, and supporting and training mother support groups and adherence counsellors in providing fertility plan discussions are crucial to improving safer conception and effective contraceptive use, which helps in having healthy babies and reducing HIV transmission.
尽管感染艾滋病毒的女性（WLHIV）与医疗服务提供者（HCPs）进行生育计划讨论很重要，但相关研究却很少。本研究从女性和提供者双方的角度，探讨了埃塞俄比亚西部WLHIV与其HCPs之间围绕生育计划讨论的看法。
2018年在埃塞俄比亚西部的四个医疗机构进行了31次访谈（27次访谈对象为WLHIV，4次访谈对象为HCPs）。数据逐字转录并翻译成英文。使用归纳主题分析法确定代码和主题。
HCPs与WLHIV在生育计划讨论的开展方面存在认知差异。27名WLHIV中只有9人报告称他们与HCPs讨论过个人生育计划。当讨论确实发生时，更安全的受孕和避孕措施的使用是主要关注点。转介到母亲支持小组、依从性咨询师以及计划生育诊所（在那里她们可以获得生殖咨询）有助于进行生育讨论。然而，HCPs或女性都未主动发起讨论、服务对象数量多且人员配备不足以及转介系统不完善是讨论生育计划的障碍。在确实进行讨论的地方，高质量互动的障碍包括：（a）未认识到女性的生育需求；（b）缺乏时间且工作过度劳累；（c）夫妻间生育意愿不匹配；（d）未向伴侣透露艾滋病毒阳性状态；（e）伴侣参与度低；（f）担心向HCP透露生育意愿会产生不良影响；以及（g）HCPs担心血清转化。
我们的研究结果凸显了制定支持生育计划讨论的政策和指南的必要性。对HCPs进行培训、提供无偏见且以服务对象为中心的生育咨询、改善服务整合以及增加人力资源对于提供咨询服务至关重要。加强伴侣参与度，以及支持和培训母亲支持小组及依从性咨询师进行生育计划讨论，对于促进更安全的受孕和有效使用避孕措施至关重要，这有助于生育健康的婴儿并减少艾滋病毒传播。
