Presentation on theme: "Factors affecting fertility desires and intentions of HIV Positive Men and Women in Post-conflict Northern Uganda: a mixed methods study Barbara Nattabi."— Presentation transcript:
1Factors affecting fertility desires and intentions of HIV Positive Men and Women in Post-conflict Northern Uganda: a mixed methods studyBarbara NattabiPrimary Supervisor: Dr Jaya EarnestCo Supervisor: Dr Sandy ThompsonCo Supervisor: Dr Jianghong LiAssociate Supervisor: Dr Christopher Garimoi Orach
2Presentation Context: Uganda, Northern Uganda, Researcher Research questions, objectives and backgroundLiterature reviewSignificanceMethodologyEthical considerations
3Uganda East Africa 30 million people High fertility rate: 7 children per womanAdult HIV prevalence 6.7% (UNAIDS 2006)Women are 52% of HIV population2.3% males, 5.0% females age group are HIV positiveMTCT 21% of HIV transmission
4Northern Uganda 2 decade civil conflict LRA rebels vs. Uganda GovernmentAcholi region and Lango region1.5 million displaced into IDP campsMalaria, TB, Cholera,Hepatitis E, HIV/AIDS,EbolaHIV prevalence 8.2%,higher than other ruralareas: 2.3%
5Prevalence of HIV Infection among ANC attendees in major towns in Uganda
6Context of researcherMedical doctor since Worked at St. Mary’s Hospital Lacor in Gulu district up to 2006.Public health specialist since 2001.For 4 years in-charge of HIV/AIDS department: VCT, PMTCT, ART programs, HIV surveillance and Research.
7Context of researcherWHO National Disease Control Officer in Kitgum district, Northern Uganda.
8Background to research study ‘Successful’ ART program supported by PEPFAR1,000 people on branded drugsGood outcomes: improved CD4 counts, reduced viral loads, ‘Lazarus’ effectsOther issues began to come up: sexual activity, pregnanciesFlabbergasted doctors, nurses, community workers: worried about MTCT, sexual transmission
10Research questions:What are the fertility desires and intentions of HIV infected men and women in post-conflict Northern UgandaWhat are the factors that influence their reproductive decision-making? Why do they make these decisions and choices?Based on their desires and intentions, what are their needs as regards HIV prevention and care programs?What family planning services are available to HIV infected women and men in Northern Uganda and how accessible are they?
11Research objectives:To describe and explore the determinants of fertility desires and intentions of the HIV infected women and men attending three HIV clinics in Gulu districtTo investigate access to family planning services among HIV infected women and men attending three HIV clinics in Gulu district and explore the structural/environmental, community and individual factors that enhance or restrict their ability to plan, space and limit their family sizes.To investigate the level of integration of family planning services with HIV/AIDS Programs at health facility and national program levelsTo suggest an appropriate model for delivery of family planning services to the HIV infected women and men attending these HIV clinics in Gulu district, with possible implications for HIV positive populations in other regions in Uganda
12Literature review 1 Mainly quantitative studies HIV affected couples desire to have childrenContinue to have children, regardless of the risks30% had become pregnant since receiving their diagnosis25% desired to have children with >50% of both women and men actually intending to have one or more children in the futureVariables associated with pregnancy desire in HIV positive women: PMTCT knowledge, younger age of mother, having few children, subjective higher ratings of overall health, male
13Literature review 2 Few qualitative studies Six themes related to reproductive decisions : spiritual and religious beliefs, knowledge and beliefs about HIV, previous experience with child bearing, attitudes of families and sex partners, personal health interpersonal motivation to have a babyDeterminants of the desire to have more children:Wanting to raise children as a way to give them purpose in lifeAs a way to regain their sense of womanhood and sexualityA need to satisfy a partner’s desire to have a childPotential for motherhood was more influential on procreative decisions vs. the health risks to mother and childFamily, spouses and societies expectations for childbearing
14Literature review 3 concerned about their own health, In contrast:Other studies have found that HIV-positive women who are aware of their status are less likely to want to have a child in the futureOnly 7% of HIV-positive women who knew their status wanted to have a childIn Kenya, eight times less likely to want to have childrenconcerned about their own health,worried that more pregnancies would make them deteriorate fasterfelt that they should take care of their existing childrenworried about transmission of HIV to future children
15SIGNIFICANCE OF THE STUDY First of its kind in post conflict Northern UgandaProvide deep insights into fertility desires and intentionsAdd to the discourse on HIV infected men and their desiresCombination of qualitative and quantitative data to provide a more holistic dimension.Provide information on programmatic needsProvide new information on how family planning services can be further integrated with HIV prevention and care services in Northern UgandaProvide better knowledge of the family planning preferences and culturally appropriate models of service delivery.
16Research methodology Mixed methods: quantitative and qualitative Quantitative data collection: QuestionnairesQuantitative data analysis: Descriptive and Inferential statisticsQuantitative resultsQualitative data collection: In-depth InterviewsQualitative data analysis: Thematic content analysisQualitative resultsCompare and contrastInterpretation Quantitative and QualitativeMixed methods: quantitative and qualitativeTriangulation: Convergence model (Creswell 2007)Equal emphasis for both armsConcurrent and separate data collection, analysisResults will be compared and contrastedFinal interpretation
17Phases of studyPhase 1Key stakeholders from Ministry of Health HIV and Reproductive Health divisions, WHO, UNICEF, UNFPASemi structured interviewsPhase 2Part 1Administrators from three health facilities in Gulu districtPart 2400 respondentsStructured interviewsPart 310 respondentsIn-depth interviews
18Quantitative arm 400 respondents Males and females 15-49 age group Stratified by age and genderConsecutive enrolmentOutpatients in 3 hospitals in Gulu districtStructured Questionnaire based on the UDHS 2006: socio-demographic information, sexual and reproductive history, fertility desires and intentionsAnalysis: Uni, Bi, Multivariate analysisSPSS and EpiInfo
19Qualitative arm 10 respondents Purposive sampling In-depth interviews Semi-structured guideTape recordingTranscribe and TranslationAnalysis in NvivoThematic content analysis
20Ethical considerations Approval from the Curtin University Human Research Ethics Committee, Uganda National Council for Science and Technology.Informed consent: objectives, procedures and implications of the study.Allowed to reach a rational, autonomous decision and will not be coerced to join the study.Information sheet and informed consent form.Free to withdraw at any stage in the study.ConfidentialityInterviews in a private room AIDS clinic and in-depth interviews will be held in the privacy of the respondents’ homes.Possible psychological harm may arise: participants will be referred to senior counselors