THE IMPLICATIONS OF REPRODUCTIVE NEEDS TO FUTURE HIV COUNSELLING

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INTRODUCTION

South Africa is a country where HIV/AIDS prevalence numbers rank among the highest in the world. According to the latest survey done by the Human Research Council on the South African National HIV prevalence, incidence and behaviour, it was estimated that during 2012, 6.4 million people (12.2%) of the population were HIV-positive (Shisana, Rehle, Simbayi, Zuma, Jooste, Zungu, Labadarios & Onoya, 2014). The survey indicated that overall females had a significantly higher HIV prevalence than males. The highest incidence of HIV among women was found in the age group 30-34 and among men in the age group 35-49.

PROBLEM STATEMENT

Despite the seemingly close link between HIV/AIDS status and reproductive concerns, reproductive needs were, until recently, mostly ignored in HIV studies. Sexual and reproductive health guidelines are not proactive in supporting HIV-positive people who desire more children (Mantell et al., 2009).

MOTIVATION FOR THE STUDY

The goal of this study is to develop an understanding of the reproductive needs of men and women using the public health system for HIV treatment. Ultimately, the results of this study should contribute to more comprehensive HIV/AIDS counselling, specifically relating to reproductive decision-making. This research will also aim to inform primary prevention and the introduction of risk reducing interventions at an early stage in situations where the individual has just been tested HIV-positive.

Factors influencing fatherhood

The limited available literature and statistics on fatherhood and HIV/AIDS indicate that this is an unexplored research area. Sherr and Barry (2004) report that between 1990 and 2001, no papers could be found with the text word “fathers” compared to five papers with the text word “motherhood” and 251 papers with the text word “mothers. » The reproductive needs of HIV-positive fathers thus require urgent consideration. The service provision in terms of fertility for HIV-positive men is still in its infancy. This is reflected in the finding that only 9.4% of men with HIV are given medical advice on reproduction (Sherr & Barry, 2004). This statement is further supported by the fact that only women took part in a study investigating South African community attitudes towards childbearing and PLWHA (Myer, Morroni & Cooper, 2006). With regards to the fact that mostly women attend prevention programs, Maharaj (2001) stated that men have an important role to play in protecting themselves and their partners, as a large percentage of women do not have control over their sexual lives in societies characterised by an unequal balance of power.

Abstract
Acknowledgements
CHAPTER 1 CONTEXTUALISING THE STUDY
1.1 INTRODUCTION
1.2 PROBLEM STATEMENT
1.3 MOTIVATION FOR THE STUDY
1.4 SETTING THE SCENE: THE DILEMMAS OF HIV AND REPRODUCTION
1.4.1 HAART and the implications for reproduction.
1.4.2 PMTCT and the implications for reproduction
1.4.3 HIV/AIDS related stigma
1.4.4 Factors influencing fatherhood
1.4.5 HIV risk reducing interventions (RRI)
1.5 RESEARCH QUESTION, AIM AND OBJECTIVES
1.6 RESEARCH DESIGN AND METHODS
1.7 OUTLINE OF THE THESIS
CHAPTER 2 RESEARCH METHODOLOGY
2.1 INTRODUCTION
2.2 RESEARCH APPROACH
2.2.1 Ontology: how reality is described
2.2.2 Epistemology: how reality is studied
2.2.3 The theoretical framework: specific research methods
2.3 RESEARCH DESIGN
2.3.1 Research Setting
2.3.2 Participants
2.3.3 Data collection
2.4 DATA ANALYSIS
2.4.1 Data interpretation
2.4.2 Substantive theory
2.4.3 Reporting a qualitative research study
2.5 CONCLUSION
CHAPTER 3 RESULTS: OPEN CODING
3.1 INTRODUCTION
3.2 OPEN CODING: INDIVIDUAL INTERVIEWS
3.2.1 Emerging code: Background information
3.2.2 Emerging code: Value of having children
3.2.3 Emerging code: Effect of not having children
3.2.4 Emerging code: Cultural acceptance/rejection
3.2.5 Emerging code: Involvement in prevention programmes
3.2.6 Emerging code: Effect of HIV on life and relationships
3.2.7 Emerging code: Awareness of risk reduction
3.3 OPEN CODING: FOCUS GROUP DISCUSSIONS
3.3.1 Emerging code: Counsellors’ perception of clients’ child des
3.3.2 Emerging code: Feelings about HIV and reproduction
3.3.3 Emerging code: Reproductive counselling provided to client
3.3.4 Emerging code: RRI/FP counselling training needs
CHAPTER 4 RESULTS: AXIAL AND SELECTIVE CODING
4.1 INTRODUCTION
4.2 AXIAL CODING: INDIVIDUAL INTERVIEWS
4.2.1 Category: Knowledge on living with HIV
4.2.2 Category: Meaning of parenthood
4.2.3 Category: Cultural norms and personal fears
4.2.4 Category: Influence of the significant other
4.3 AXIAL CODING: FOCUS GROUP DISCUSSIONS
4.3.1 Category: Counsellors’ perception
4.3.2 Category: Counsellors’ knowledge regarding RRI and FP
4.4 SELECTIVE CODING
4.5 THE CORE CATEGORY
4.6 CONCLUSION
CHAPTER 5 INTEGRATING THE LITERATURE AND RESULTS
5.1 INTRODUCTION
5.2 UNDERSTANDING THE REPRODUCTIVE NEEDS OF PLWHA
5.2.1 Gender identity within the family and community
5.2.2 Gender inequality in procreation
5.2.3 Community stigmatisation of HIV
5.3 THE LACK OF RRI INFORMATION, TRAINING AND COUNSELLING
5.3.1 HIV counsellor training
5.3.2 Access to HIV services
5.4 CONCLUSION
CHAPTER 6 CONCLUSION: THE SUBSTANTIVE THEORY AND IMPLICATIONS
6.1 INTRODUCTION
6.2 THE SUBSTANTIVE THEORY
6.3 THE IMPLICATIONS OF REPRODUCTIVE NEEDS TO FUTURE HIV COUNSELLING
6.4 CONTRIBUTION OF THE STUDY
6.5 IMITATIONS IN THE STUDY
6.6 RECOMMENDATIONS
6.7 PROPOSED FUTURE RESEARCH
6.8 CONCLUSION

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REPRODUCTIVE NEEDS OF MEN AND WOMEN LIVING WITH HIV: IMPLICATIONS FOR FAMILY PLANNING COUNSELLING