Clinical Research Scientist, Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
Social Scientist, University of Zimbabwe Clinical Trials Research Center, Harare, Zimbabwe.
Sex Reprod Health Matters. 2024 Dec;32(1):2366587. doi: 10.1080/26410397.2024.2366587. Epub 2024 Jul 15.
Decision-making on childbearing and safer conception use in HIV sero-different couples involves an intricate balance of individual desires and perceived HIV acquisition risk. This paper addresses an important knowledge gap regarding HIV sero-different couples' considerations and the relationship and power dynamics involved when deciding to use a safer conception method. Between February and June 2019, we conducted semi-structured in-depth interviews among 14 men and 17 women, representing 17 couples, who exited the SAFER study - a pilot study assessing the feasibility, acceptability and cost-effectiveness of a safer conception programme for HIV sero-different couples in Zimbabwe. All couples in SAFER were provided with a choice of safer conception methods and were followed for up to 12 months of pregnancy attempts and 3 months following pregnancy. While couples generally perceived their safer conception discussions to be easy and consensus-driven, the decision-making process also involved complex gender dynamics and trade-offs in relationship power, which resulted in differing interpretations of what constituted a joint or shared couple decision. Participants regarded effective couple communication as an essential component of and precursor to good safer conception conversations and requested additional training in couple communication. Couples relied on information from healthcare providers to kickstart their safer conception discussions. Safer conception programmes should address relationship power imbalances, promote effective couple communication and offer healthcare provider support to enable HIV sero-different couples to make informed choices about conception in a manner that upholds their safety and reproductive autonomy.
在 HIV 血清学不同的夫妇中，关于生育和更安全的受孕方式的决策涉及到个人愿望和感知的 HIV 感染风险之间的复杂平衡。本文针对 HIV 血清学不同的夫妇在决定使用更安全的受孕方法时的考虑因素以及所涉及的关系和权力动态，解决了一个重要的知识空白。2019 年 2 月至 6 月，我们对 14 名男性和 17 名女性（代表 17 对夫妇）进行了半结构式深入访谈，这些夫妇都参与了 SAFER 研究 - 这是一项评估在津巴布韦为 HIV 血清学不同的夫妇提供更安全受孕方案的可行性、可接受性和成本效益的试点研究。在 SAFER 中，所有夫妇都可以选择更安全的受孕方法，并在怀孕尝试期间和怀孕后 3 个月内进行最多 12 个月的随访。尽管夫妇普遍认为他们的更安全受孕讨论是轻松和共识驱动的，但决策过程也涉及到复杂的性别动态和关系权力的权衡，这导致了对共同或共同夫妇决策的不同解释。参与者认为有效的夫妻沟通是良好的更安全受孕对话的重要组成部分和前提，并要求在夫妻沟通方面进行额外的培训。夫妇依赖于医疗保健提供者提供的信息来启动他们的更安全受孕讨论。更安全的受孕方案应解决关系权力失衡问题，促进有效的夫妻沟通，并提供医疗保健提供者的支持，以使 HIV 血清学不同的夫妇能够以维护他们的安全和生殖自主权的方式对受孕做出明智的选择。
