AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #159 - Toward improving SRH counselling for people living with HIV: "Pills are not going to build me up if they come into a person who has a heavy heart.”
Authors: Presenting Author: Prof Diane Cooper - University of Cape Town
Additional Authors: Dr. Joanne Mantell, Dr. Jennifer Moodley, Dr. Karen Jennings, Ms. Nomazizi Cishe, Mr. Ntobeko Nywagi, Prof. Zena Stein,
Aim: Addressing women and men living with HIV with sexual and reproductive health needs (SRH) is an urgent concern in countries with advanced HIV epidemics, where a sizeable population early in their reproductive years is already HIV-positive. To address the reproductive needs of people living with HIV (PLWH) adequately, counselling needs to include HIV’s impact on PLWH’s sexual and reproductive lives. This study informed the development of a structural intervention to address reproductive health decision-making.
Method / Issue: We successful completed semi-structured individual in-depth interviews with a cohort of 40 women and men living with HIV in the public sector HIV care system in Cape Town, South Africa soon after diagnosis, and at 6-9 months and 12-18 months after diagnosis. Aside from key reproductive health questions, the interviews explored: impact of HIV on their lives, including sexual lives; HIV status disclosure; sexual risk decisions; and sources of support.
Results / Comments: Women and men’s mean age was 33 and 37 years. Eighty-four percent of men and 76% of women reported having a main sexual partner. Sixty-one percent of men and 41% of women knew the HIV status of their main sexual partner. Some experienced shock/disbelief, anxiety, and thoughts about death on diagnosis with HIV, while others felt resigned or expected this diagnosis. Most HIV+ women and men moved to greater acceptance over time. Anxiety continued around practical issues, including jobs, income, food security and housing. Participants’ anxiety diminished if these were secured. Disclosure increased over time, primarily to a few trusted individuals - wives/girlfriends and selected family members. Barriers to disclosing to family included the families not living in Cape Town and potential stigmatization. Tangible benefits to disclosure included support and love/kindness and mutual assistance, particularly in reducing sexual risk. Some individuals reported no change in sexual desire/functioning, whereas others reported reduced libido and difficulties in sexual performance. Among men, this was perceived to be due to HIV. At baseline, most HIV+ women and men reported condom use, while at follow-up there was greater willingness to acknowledge difficulties with consistent use. Safer conception was a key issue for men and women. Common sources of support included partners, family, friends and support groups of others living with HIV. Health care providers were seen as key sources of information and advice and although they had not done so, felt comfortable with discussing changing in sexual functioning and fertility desires with them. Material practical advice was important. PLWH coped positively by keeping physically well and enjoying daily life pleasures. Key challenges to coping included mental health issues (anxiety and depression) for both women and men and alcohol for men. Men were more likely to report using alcohol as a means of coping initially; however, in combination with antiretroviral treatment, substance abuse diminished overtime.
Discussion: Findings suggest that reproductive counselling for PLWH is critical. Clients must be provided with space to raise issues related to sexual desire and functioning problems, feelings of depression/mental health problems, discussing life plans about having/not having children, and advice on practical material problems
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