Facilitators and Barriers to Reproductive Health Information Among Women and Men Affected By HIV

Purpose: To examine and explore factors which facilitate accessing reproductive health information and treatment (RHI/T) for women and men living with HIV and the barriers that exist when attempting to access reproductive health information and treatment.

Methods: This qualitative grounded theory study utilized face to face interviews with 8 men and 6 women who identified as wanting to have biological children, had been diagnosed with HIV, and/or had a partner living with HIV. The study took place in the U.S. over 8 months in 2014-2015.  Interviews were audio recorded and transcribed verbatim by the PI. Charmaz’s constructivist perspective of Grounded Theory was used as the framework for data analysis and interpretation. 

Results: Individuals living with HIV (have the disease, have a partner with the disease, or both have the disease) desire biological children. The primary concern was to have a healthy baby and not transmit the infection to the baby. The secondary concern was to protect the partner from infection. Having a biological child meant doing something positive with one’s life, leaving behind a sense of “self” after death, and to right some of what had been wrong in their life. Facilitators to accessing RHI/T were good relationships with HCPs, family and the HIV support community. The internet was also described as a facilitator although participants felt information from the internet needed a source of validation. Barriers to RHI/T were the health care system which is described by participants as inconsistent and specialized. Family can also be a barrier in the lack of understanding and support for desiring children.

Conclusion: Findings suggest that barriers to accessing reproductive health care exist at many levels. Health care providers may not be asking patients with HIV about reproductive intention, care is often shared amongst many providers including HIV specialists, Ob/Gyn providers, primary care providers and each may assume that another provider is providing reproductive health care. There are missed opportunities for sharing information due to brief appointment times that are focused on managing HIV. Patients may inadvertently contribute by having an expectation that the HCP will broach the subject. They may also have sensed a negative attitude about wanting children so they are reluctant to initiate the conversation. Facilitators can be in the form of support groups that often have HCP or health educators share information in a group setting, the ability to access information using the internet and relationships with HCPs. Nursing and interprofessional interventions to improve the accessibility of reproductive health information are increasingly important. These interventions may be in the form of asking patients to develop a reproductive life plan (RLP) and to use that plan as the starting point for discussing reproductive intention. Developing and utilizing an individual reproductive life plan may impact both the rates of unintended pregnancies and utilization of preconception care. Further studies should be conducted to evaluate the acceptance of RLPs amongst this community.