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:
Factors affecting fertility desires and intentions of HIV Positive Men and Women in Post-conflict Northern Uganda: a mixed methods study Barbara Nattabi Primary Supervisor: Dr Jaya Earnest Co Supervisor: Dr Sandy Thompson Co Supervisor: Dr Jianghong Li Associate Supervisor: Dr Christopher Garimoi Orach
Presentation Context: Uganda, Northern Uganda, Researcher Research questions, objectives and background Literature review Significance Methodology Ethical considerations
Uganda East Africa 30 million people High fertility rate: 7 children per woman Adult HIV prevalence 6.7% (UNAIDS 2006) Women are 52% of HIV population 2.3% males, 5.0% females age group are HIV positive MTCT 21% of HIV transmission
Northern Uganda 2 decade civil conflict LRA rebels vs. Uganda Government Acholi region and Lango region 1.5 million displaced into IDP camps Malaria, TB, Cholera, Hepatitis E, HIV/AIDS, Ebola HIV prevalence 8.2%, higher than other rural areas: 2.3%
Prevalence of HIV Infection among ANC attendees in major towns in Uganda
Context of researcher Medical doctor since Worked at St. Marys Hospital Lacor in Gulu district up to Public health specialist since For 4 years in-charge of HIV/AIDS department: VCT, PMTCT, ART programs, HIV surveillance and Research.
Context of researcher WHO National Disease Control Officer in Kitgum district, Northern Uganda.
Background to research study Successful ART program supported by PEPFAR 1,000 people on branded drugs Good outcomes: improved CD4 counts, reduced viral loads, Lazarus effects Other issues began to come up: sexual activity, pregnancies Flabbergasted doctors, nurses, community workers: worried about MTCT, sexual transmission
AIDS Patients in Northern Uganda
Research questions : What are the fertility desires and intentions of HIV infected men and women in post-conflict Northern Uganda What 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?
Research 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 district To 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 levels To 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
Literature review 1 Mainly quantitative studies HIV affected couples desire to have children Continue to have children, regardless of the risks 30% had become pregnant since receiving their diagnosis 25% desired to have children with >50% of both women and men actually intending to have one or more children in the future Variables associated with pregnancy desire in HIV positive women: PMTCT knowledge, younger age of mother, having few children, subjective higher ratings of overall health, male
Literature 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 baby Determinants of the desire to have more children: Wanting to raise children as a way to give them purpose in life As a way to regain their sense of womanhood and sexuality A need to satisfy a partners desire to have a child Potential for motherhood was more influential on procreative decisions vs. the health risks to mother and child Family, spouses and societies expectations for childbearing
Literature review 3 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 future Only 7% of HIV-positive women who knew their status wanted to have a child In Kenya, eight times less likely to want to have children concerned about their own health, worried that more pregnancies would make them deteriorate faster felt that they should take care of their existing children worried about transmission of HIV to future children
SIGNIFICANCE OF THE STUDY First of its kind in post conflict Northern Uganda Provide deep insights into fertility desires and intentions Add to the discourse on HIV infected men and their desires Combination of qualitative and quantitative data to provide a more holistic dimension. Provide information on programmatic needs Provide new information on how family planning services can be further integrated with HIV prevention and care services in Northern Uganda Provide better knowledge of the family planning preferences and culturally appropriate models of service delivery.
Research methodology Mixed methods: quantitative and qualitative Triangulation: Convergence model (Creswell 2007) Equal emphasis for both arms Concurrent and separate data collection, analysis Results will be compared and contrasted Final interpretation Quantitative data collection: Questionnaires Quantitative data analysis: Descriptive and Inferential statistics Quantitative results Qualitative data collection: In-depth Interviews Qualitative data analysis: Thematic content analysis Qualitative results Compare and contrast Interpretation Quantitative and Qualitative
Phases of study Phase 1Key stakeholders from Ministry of Health HIV and Reproductive Health divisions, WHO, UNICEF, UNFPA Semi structured interviews Phase 2Part 1Administrators from three health facilities in Gulu district Semi structured interviews Part 2400 respondentsStructured interviews Part 310 respondentsIn-depth interviews
Quantitative arm 400 respondents Males and females age group Stratified by age and gender Consecutive enrolment Outpatients in 3 hospitals in Gulu district Structured Questionnaire based on the UDHS 2006: socio-demographic information, sexual and reproductive history, fertility desires and intentions Analysis: Uni, Bi, Multivariate analysis SPSS and EpiInfo
Qualitative arm 10 respondents Purposive sampling In-depth interviews Semi-structured guide Tape recording Transcribe and Translation Analysis in Nvivo Thematic content analysis
Ethical 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. Confidentiality Interviews 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