Benefits and Challenges of Safer-Conception Counseling for HIV Serodiscordant Couples in Uganda
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.
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.
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.
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.
Deborah Mindry is research anthropologist, Center for Social Medicine and Humanities, Semel Institute, University of California, Los Angeles, CA, USA. Mahlet A. Woldetsadik is assistant policy researcher, and Glenn Wagner is senior behavioral scientist, RAND Corporation, Santa Monica, CA, USA. Rhoda K. Wanyenze is associate professor and dean, School of Public Health, and Jolly Beyeza-Kashesya is senior consultant obstetrician/gynecologist, Department of Obstetrics and Gynecology, School of Medicine—both at the College of Health Sciences, Makerere University, Kampala, Uganda. Sarah Finocchario-Kessler is associate professor, Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA. Kathy Goggin is director, Health Services and Outcomes Research, Children's Mercy Kansas City, University of Missouri, Kansas City, MO, USA.