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Table 2 Healthcare providers’ perception regarding fertility plan discussions with women living with HIV in western Ethiopia

From: “They haven’t asked me. I haven’t told them either”: fertility plan discussions between women living with HIV and healthcare providers in western Ethiopia

Themes/categories

Quote Code

Quote

Discussing fertility plans

 

1

They [women] discuss with us when they visit our center (HCP#2).

2

Moreover, in the treatment rooms, patients are asked information on their desires on the ART follow-up chart. This is important to know the status of our patients (HCP#4).

Safer conception strategies

3

To have a child, viral load should be less than 1000 and CD4 [count] should be greater than 350 [cells/μL] (HCP#1).

4

If their weight is low, in turn, there is the possibility that their CD4 is low, we advise them not to have a child. We provide them counselling if their CD4 [count] is less than 500 and the viral load above 1000. Besides, we encourage both [a wife and husband] not to have a child during initial HIV drug use and low CD4 count (HCP#4).

5

The main thing is they should not have OI [opportunistic infections] and women’s clinical stage is assessed by providers especially for those [with] clinical stages of 3 and 4 (HCP#3).

6

Anyhow, they have to wait for the ovulation period in order to have sexual intercourse without condoms, in turn, to get a child. Afterwards, they have to use condoms regularly. In principle, a healthcare worker cannot counsel sex without condoms with a HIV-infected one. It is a major way of its spread. Accordingly, health worker’s advice is telling the truth behind sexual [condomless] engagement. The choice and the move for [decision to have] a child through having [unprotected] sex with a HIV-positive person depends on the decision of the partner, or one of them (HCP#3).

7

Since she was on ART for a long period and her CD4 [count] was also not in clinical-stage condition, her child was not reactive (HCP#3).

Contraceptive discussions

8

We ask their choice [s], inform them the available types of contraception and ask [them] any complaint regarding previously used contraception. If it caused bleeding, prolonged [menstrual] period, we change for them by asking the suitable contraception. [But] we can’t give them oral contraceptives … We counsel them not to use hormonal contraception [OCP], since this type of contraceptive methods may weaken ART they use (HCP#1).

9

For long-acting family planning service [s], we do not restrict women and women can choose freely (HCP#4).

10

Among contraception methods, they can use condoms and IUD [s] since they lack hormone [s]. ART drugs have an impact on hormonal contraception [OCP] and can cause pregnancy. Injectables [short-acting] and implants are also possible [to use] (HCP#1).

11

For people living with HIV, contraceptive methods like pills or depo or implants only are not recommended. Because there are opportunistic infections; viral load can be transmitted; HIV of the husband can be transmitted [cross infection] (HCP#3).

12

We provide short-acting contraception at our clinic [HIV clinic], whereas long term contraception is provided at family planning unit [s] (HCP#4).

13

Some clients say, ‘I become pregnant while I’m using depo (injectables)’, while others say, ‘I was using implant during my conception’. We counsel them there may be a failure of contraception (HCP#3).