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Application of an ecological framework to examine barriers to the adoption of safer conception strategies by HIV-affected couples

机译：应用生态框架审查受艾滋病毒影响的夫妇采用更安全的受孕策略的障碍

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Safer conception interventions can significantly reduce the risk of horizontal HIV transmission between HIV-serodiscordant partners. However, prior to implementing safer conception interventions, it is essential to understand potential barriers to their adoption so that strategies can be developed to overcome these barriers. This paper examines potential barriers to the adoption of safer conception strategies by HIV-affected couples in Iringa, Tanzania using an ecological framework. We interviewed 30 HIV-positive women, 30 HIV-positive men and 30 health providers engaged in delivering HIV-related services. We also conducted direct observations at five health facilities. Findings suggest that there are multiple barriers to safer conception that operate at the individual, relational, environmental, structural, and super-structural levels. The barriers to safer conception identified are complex and interact across these levels. Barriers at the individual level included antiretroviral adherence, knowledge of HIV status, knowledge and acceptability of safer conception strategies, and poor nutrition. At the relational level, unplanned pregnancies, non-disclosure of status, gendered power dynamics within relationships, and patient-provider interactions posed a threat to safer conception. HIV stigma and distance to health facilities were environmental barriers to safer conception. At the structural level there were multiple barriers to safer conception, including limited safer conception policy guidelines for people living with HIV (PLHIV), lack of health provider training in safer conception strategies and preconception counseling for PLHIV, limited resources, and lack of integration of HIV and sexual and reproductive health services. Poverty and gender norms were super-structural factors that influenced and reinforced barriers to safer conception, which influenced and operated across different levels of the framework. Multi-level interventions are needed to ensure adoption of safer conception strategies and reduce the risk of HIV transmission between partners within HIV-serodiscordant couples.
机译：更安全的受孕干预措施可以显着降低艾滋病毒血清不一致伙伴之间艾滋病毒水平传播的风险。但是，在实施更安全的概念干预措施之前，必须了解采用这些措施的潜在障碍，以便可以制定出克服这些障碍的策略。本文使用生态框架研究了坦桑尼亚伊林加受艾滋病毒影响的夫妇采用更安全的受孕策略的潜在障碍。我们采访了30位HIV阳性女性，30位HIV阳性男性和30位从事提供HIV相关服务的医疗服务提供者。我们还对五个医疗机构进行了直接观察。研究结果表明，在个人，关系，环境，结构和超结构层面上，存在着影响更安全观念的多个障碍。所确定的更安全观念的障碍是复杂的，并且在这些层面上相互作用。个人层面的障碍包括抗逆转录病毒依从性，对艾滋病毒状况的了解，对更安全的受孕策略的了解和接受程度以及营养不良。在关系层面，计划外的怀孕，身份的不公开，人际关系中的性别力量动态以及患者与提供者的互动都对更安全的观念构成了威胁。艾滋病毒的污名化以及与卫生设施的距离是实现更安全观念的环境障碍。在结构层面上，存在着更安全概念的多重障碍，包括针对艾滋病毒感染者的有限安全概念政策指南，缺乏对安全概念战略的卫生保健人员培训以及针对艾滋病毒的孕前咨询，资源有限以及缺乏对艾滋病毒的整合艾滋病毒以及性健康和生殖健康服务。贫穷和性别规范是影响并加强阻碍人们获得更安全观念的超结构性因素，这些因素影响和作用于框架的不同层次。需要采取多层次的干预措施，以确保采用更安全的受孕策略，并降低艾滋病毒血清不一致夫妇之间伴侣之间艾滋病毒传播的风险。

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