Abstract #78  -  Reproductive decision-making and experience of pregnancy and childbirth following HIV diagnosis a longitudinal qualitative study of experience and care in Northern Ireland.
Authors:   Presenting Author:   Ms Carmel Kelly - Queen's University Belfast
Additional Authors:  Dr Fiona Alderdice, Dr Maria Lohan, Dr Dale Spence,
Aim: While still a relatively low seroprevalence region, Northern Ireland has experienced a dramatic increase in new heterosexually acquired HIV diagnoses in recent years, influenced in part by migration but also earlier detection through the introduction of antenatal screening, resulting in substantially more HIV positive pregnant women having been identified than were ever anticipated or planned for. The aim of this study is to explore the real life contexts in which men and women, affected by a diagnosis of HIV, make reproductive decisions and their experience of pregnancy, childbirth and the care they receive throughout this journey. In particular, the study aims to explore the experiences from the perspective of HIV positive men and three groups of women, those who were aware of their diagnosis before becoming pregnant, those who learn of their diagnosis during antenatal screening and HIV negative women choosing a pregnancy with a HIV positive partner.
Method / Issue: A qualitative longitudinal methodology was chosen in order to capture biographical changes and continuities in individuals experiences and health and social care needs as participants moved from one stage of the reproductive trajectory to the next. Eleven women and five men were interviewed, mostly twice, and up to a maximum of four times at different stages in their journey through the reproductive trajectory. The analysis will be multi-staged, at first focusing on each individual narrative and biographical transition between the interviews, second, a comparative thematic analysis to identify themes of commonality and difference across the interviews and third an iterative analysis designed to go between emergent experiential themes from the study data and the wider body of work on HIV and pregnancy.
Results / Comments: This paper will therefore introduce the study and discuss some of the methodological challenges encountered, including recruitment, confidentiality and individual versus couple interviewing. In addition, interim results will be presented which provide insight into the similarities and differences in the experiences and health and social care needs of pregnant women who have received a diagnosis following routine antenatal screening compared to women who had knowledge of their HIV status prior to conception. In particular, participants narratives reveal how their perception of the pervading social discourses on HIV requires their vigilance, even in their interactions with health care professionals, to protect themselves and their families.
Discussion: It is hoped that the study findings will contribute to evidence based practice by generating an understanding of the patient�s experiences of care, serving as a catalyst for health care professionals to think about, or better understand the contexts, relationships and experiences of others in their care. It is also hoped that the findings will serve as the basis for the generation of patient-centered interventions, as a wider range of health care professionals, particularly midwives and obstetricians are involved in the reproductive counselling and care of HIV positive women and their partners.
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