Browsing by Author "Harries, Jane"
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- ItemOpen AccessA multidimensional approach to inform family planning needs, preferences and behaviours amongst women in South Africa through body mapping(2019-11-06) Harries, Jane; Constant, Deborah; Wright, Vanessa; Morroni, Chelsea; Müller, Alex; Colvin, Christopher JAbstract Background In recent decades there have been great improvements in the reproductive health of women in low- and middle-income countries and increases in the use of modern contraceptive methods. Nonetheless, many women are not able to access information, contraceptive technologies and services that could facilitate preventing unintended pregnancies and planning the number and timing of desired pregnancies. In South Africa, the contraceptive prevalence rate is 64.6%. However, this relatively high contraceptive prevalence rate masks problems with quality contraceptive service delivery, equitable access, and women’s ability to correctly and consistently, use contraceptive methods of their choice. This study set out to understand the specific family planning and contraceptive needs and behaviours of women of reproductive age in South Africa, through a lived experience, multisensory approach. Methods Participatory qualitative research methods were used including body mapping workshops amongst reproductive aged women recruited from urban and peri urban areas in the Western Cape South Africa. Data including body map images were analysed using a thematic analysis approach. Results Women had limited biomedical knowledge of the female reproductive anatomy, conception, fertility and how contraceptives worked, compounded by a lack of contraceptive counseling and support from health care providers. Women’s preferences for different contraceptive methods were not based on a single, sensory or experiential factor. Rather, they were made up of a composite of sensory, physical, social and emotional experiences underscored by potential for threats to bodily harm. Conclusions This study highlighted the need to address communication and knowledge gaps around the female reproductive anatomy, different contraceptive methods and how contraception works to prevent a pregnancy. Women, including younger women, identified sexual and reproductive health knowledge gaps themselves and identified these gaps as important factors that influenced uptake and effective contraceptive use. These knowledge gaps were overwhelmingly linked to poor or absent communication and counseling provided by health care providers. Body mapping techniques could be used in education and communication strategies around sexual and reproductive health programmes in diverse settings.
- ItemOpen AccessAbortion services in South Africa : challenges and barriers to safe abortion care : health care providers' perspectives(2010) Harries, Jane; Colvin, Christopher JUnsafe abortion is a preventable phenomenon and continues to be a major public health problem in many countries especially in the developing world. Despite abortion being legally available in South Africa after a change in legislation in 1996, barriers to accessing safe abortion services continue to exist. These barriers include provider opposition to abortion, and a shortage of trained and willing abortion providers. The dearth of abortion providers undermines the availability of safe, legal abortion, and has serious implications for women's access to abortion services and health service planning.
- ItemOpen AccessAccuracy of assessment of eligibility for early medical abortion by community health workers in Ethiopia, India and South Africa(Public Library of Science, 2016) Johnston, Heidi Bart; Ganatra, Bela; Nguyen, My Huong; Habib, Ndema; Afework, Mesganaw Fantahun; Harries, Jane; Iyengar, Kirti; Moodley, Jennifer; Lema, Hailu Yeneneh; Constant, Deborah; Sen, SwapnaleenObjective To assess the accuracy of assessment of eligibility for early medical abortion by community health workers using a simple checklist toolkit. Design Diagnostic accuracy study. Setting Ethiopia, India and South Africa. METHODS: Two hundred seventeen women in Ethiopia, 258 in India and 236 in South Africa were enrolled into the study. A checklist toolkit to determine eligibility for early medical abortion was validated by comparing results of clinician and community health worker assessment of eligibility using the checklist toolkit with the reference standard exam. RESULTS: Accuracy was over 90% and the negative likelihood ratio <0.1 at all three sites when used by clinician assessors. Positive likelihood ratios were 4.3 in Ethiopia, 5.8 in India and 6.3 in South Africa. When used by community health workers the overall accuracy of the toolkit was 92% in Ethiopia, 80% in India and 77% in South Africa negative likelihood ratios were 0.08 in Ethiopia, 0.25 in India and 0.22 in South Africa and positive likelihood ratios were 5.9 in Ethiopia and 2.0 in India and South Africa. CONCLUSION: The checklist toolkit, as used by clinicians, was excellent at ruling out participants who were not eligible, and moderately effective at ruling in participants who were eligible for medical abortion. Results were promising when used by community health workers particularly in Ethiopia where they had more prior experience with use of diagnostic aids and longer professional training. The checklist toolkit assessments resulted in some participants being wrongly assessed as eligible for medical abortion which is an area of concern. Further research is needed to streamline the components of the tool, explore optimal duration and content of training for community health workers, and test feasibility and acceptability.
- ItemOpen AccessAccuracy of gestational age estimation from last menstrual period among women seeking abortion in South Africa, with a view to task sharing: a mixed methods study(BioMed Central, 2017-08-22) Constant, Deborah; Harries, Jane; Moodley, Jennifer; Myer, LandonBackground: The requirement for ultrasound to establish gestational age among women seeking abortion can be a barrier to access. Last menstrual period dating without clinical examination should be a reasonable alternative among selected women, and if reliable, can be task-shared with non-clinicians. This study determines the accuracy of gestational age estimation using last menstrual period (LMP) assessed by community health care workers (CHWs) , and explores providers’ and CHWs’ perspectives on task sharing this activity. The study purpose is to expand access to early medical abortion services. Methods: We conducted a multi-center cross-sectional study at four urban non-governmental reproductive health clinics in South Africa. CHWs interviewed women seeking abortion, recorded their LMP and gestational age from a pregnancy wheel if within 63 days. Thereafter, providers performed a standard examination including ultrasound to determine gestational age. Lastly, investigators calculated gestational age for all LMP dates recorded by CHWs. We compared mean gestational age from LMP dates to mean gestational age by ultrasound using t-tests and calculated proportions for those incorrectly assessed as eligible for medical abortion from LMP. In addition, in-depth interviews were conducted with six providers and seven CHWs. Results: Mean gestational age was 5 days (by pregnancy wheel) and 9 days (by LMP calculation) less than ultrasound gestational age. Twelve percent of women were eligible for medical abortion by LMP calculation but ineligible by ultrasound. Uncertainty of LMP date was associated with incorrect assessment of gestational age eligibility for medical abortion (p = 0.015). For women certain their LMP date was within 56 days, 3% had ultrasound gestational ages >70 days. In general, providers and CHWs were in favour of task sharing screening and referral for abortion, but were doubtful that women reported accurate LMP dates. Different perspectives emerged on how to implement task sharing gestational age eligibility for medical abortion. Conclusions: If LMP recall is within 56 days, most women will be eligible for early medical abortion and LMP can substitute for ultrasound dating. Task sharing gestational age estimation is feasible in South Africa, but its implementation should meet women’s privacy needs and address healthcare workers’ concerns on managing any procedural risk.
- ItemOpen AccessAn exploration of knowledge, attitudes and practices of primary health care providers providing contraceptive and family planning services in Cape Town, South Africa: a qualitative study(2020) Fataar, Kulthum; Harries, Jane; Zweigenthal, VirginiaHealth care providers can play a significant role in empowering women to make informed decisions when selecting suitable contraceptive methods during contraceptive counselling. This study explores the experiences and perceptions of primary health care providers delivering contraceptives services in Cape Town to gain a deeper understanding of the delivery of contraceptive services. Ten in-depth interviews were conducted at five public primary health care facilities in urban areas in Cape Town, South Africa. Eligible participants included primary health care providers providing contraceptive services and willing to participate in the study. The qualitative software package NVivo was used to sort and manage data. Data was analysed using a thematic analysis approach. Overall, providers emphasized supporting women in contraceptive decision-making. Sexual and reproductive health training increased providers confidence to deliver appropriate contraceptive services. Furthermore, contraceptive prescribing practices were also influenced by medical eligibility criteria and women's preferred bleeding patterns. However, contraceptive prescribing practices were also influenced by providers' attitudes towards younger and older women. Challenges experienced by providers when providing contraceptive services included: contraceptive stockouts; time constraints of employed women accessing the service; and work pressure due to providing other health services. Health care providers play a critical role in facilitating women's right to accessing high quality contraceptive services. Providers in the study perceived themselves as negotiators during contraceptive counselling by considering both women's preferences and provider recommendations for contraception, whilst enabling women to make informed contraceptive decisions through provision of reproductive health information. Consequently, shifting contraceptive counselling to focus on shared decision-making may encourage autonomy during decision-making and help to limit the influence of provider attitudes on contraceptive prescribing and counselling.
- ItemOpen AccessBarriers and facilitators to colposcopy attendance following an abnormal pap smear: patient and provider perspectives(2014) Dawood, Shanaaz; Moodley, Jennifer; Harries, JaneCervical cancer is a public health problem particularly in developing countries where incidence of cervical cancer remains high, either due to a lack of screening or poorly organised screening programmes. Cytology based cervical screening is only beneficial if women with abnormal Papanicolaou (Pap) smears are appropriately investigated. Colposcopy attendance following an abnormal Pap smear is a major problem in South Africa. The aim of this study was to explore barriers and facilitators to colposcopy attendance following an abnormal Pap smear result. A qualitative study was conducted at a public sector tertiary hospital colposcopy service and two primary health care clinics in Cape Town, South Africa. Data collection included 32 semi-structured interviews: 12 face-to-face interviews with colposcopy clinic attendees, 12 telephonic interviews with colposcopy clinic non- attendees and 8 face-to-face interviews with health care providers. Client interviews explored barriers and facilitators to colposcopy attendance; knowledge and experiences of Pap smears, cervical cancer and the colposcopy procedure; scheduling of colposcopy appointments; provider communication; reasons for non-attendance; and community support and beliefs. Provider interviews explored barriers and facilitators to colposcopy attendance from a provider’s perspective, the colposcopy referral process, and provider challenges in the provision of Pap smear or colposcopy services. Results from this study highlighted that the main barriers to colposcopy attendance were: poor levels of knowledge of the importance of a Pap smear and the colposcopy procedure; a lack of awareness of cervical cancer as a disease; a fear of cancer; the asymptomatic nature of the disease; and transport costs. Health system factors that impacted negatively on colposcopy clinic attendance included: the inadequate feedback of Pap smear results – clients were not informed of Pap smear results or colposcopy appointments and therefore did not attend; a disjointed system of colposcopy scheduling; and staff shortages which resulted in less time for client tracking. Factors which promoted colposcopy attendance included experiencing symptoms; a family history of cancer due to the experience with death; colposcopy services situated closer to clients; and social support receive d from family members. Addressing these barriers requires promoting client knowledge with educational materials and improving provider communication with clients. In addition, establishing colposcopy services closer to clients and standardising the system of colposcopy scheduling can improve colposcopy adherence.
- ItemOpen AccessBody Mapping: to explore the embodied experiences of contraceptive methods and family planning with women in South Africa(2018-09-15) Harries, Jane; Solomon, JaneIn this booklet we share some of the body mapping images and stories which formed part of a Bill & Melinda Gates Foundation funded study titled: A multidimensional approach to inform family planning needs, preferences and behaviours amongst women in South Africa. The body mapping images and visual stories provide an innovative and participatory research method to uncover women’s lived and embodied experiences of their reproductive systems including reproduction, fertility, conception, contraception and family planning. The booklet is intended for policy makers, health care providers, researchers, academics and community and non- governmental organisations working in the sexual and reproductive health arena.
- ItemOpen AccessClinical outcomes and women's experiences before and after the introduction of mifepristone into second-trimester medical abortion services in South Africa(Public Library of Science, 2016) Constant, Deborah; Harries, Jane; Malaba, Thokozile; Myer, Landon; Patel, Malika; Petro, Gregory; Grossman, DanielObjective To document clinical outcomes and women's experiences following the introduction of mifepristone into South African public sector second-trimester medical abortion services, and compare with historic cohorts receiving misoprostol-only. METHODS: Repeated cross-sectional observational studies documented service delivery and experiences of women undergoing second-trimester medical abortion in public sector hospitals in the Western Cape, South Africa. Women recruited to the study in 2008 (n = 84) and 2010 (n = 58) received misoprostol only. Those recruited in 2014 (n = 208) received mifepristone and misoprostol. Consenting women were interviewed during hospitalization by study fieldworkers with respect to socio-demographic information, reproductive history, and their experiences with the abortion. Clinical details were extracted from medical charts following discharge. Telephone follow-up interviews to record delayed complications were conducted 2-4 weeks after discharge for the 2014 cohort. RESULTS: The 2014 cohort received 200 mg mifepristone, which was self-administered 24-48 hours prior to admission. For all cohorts, following hospital admission, initial misoprostol doses were generally administered vaginally: 800 mcg in the 2014 cohort and 600 mcg in the earlier cohorts. Women received subsequent doses of misoprostol 400 mcg orally every 3-4 hours until fetal expulsion. Thereafter, uterine evacuation of placental tissue was performed as needed. With one exception, all women in all cohorts expelled the fetus. Median time-to-fetal expulsion was reduced to 8.0 hours from 14.5 hours (p<0.001) in the mifepristone compared to the 2010 misoprostol-only cohort (time of fetal expulsion was not recorded in 2008). Uterine evacuation of placental tissue using curettage or vacuum aspiration was more often performed (76% vs. 58%, p<0.001) for those receiving mifepristone; major complication rates were unchanged. Hospitalization duration and extreme pain levels were reduced (p<0.001), but side effects of medication were similar or more common for the mifepristone cohort. Overall satisfaction remained unchanged (95% vs. 91%), while other acceptability measures were higher (p<0.001) for the mifepristone compared to the misoprostol-only cohorts. CONCLUSION: The introduction of a combined mifepristone-misoprostol regimen into public sector second-trimester medical abortion services in South Africa has been successful with shorter time-to-abortion events, less extreme pain and greater acceptability for women. High rates of uterine evacuation for placental tissue need to be addressed.
- ItemOpen AccessConscientious objection and its impact on abortion service provision in South Africa: a qualitative study(2014-02-26) Harries, Jane; Cooper, Diane; Strebel, Anna; Colvin, Christopher JAbstract Background Despite abortion being legally available in South Africa after a change in legislation in 1996, barriers to accessing safe abortion services continue to exist. These barriers include provider opposition to abortion often on the grounds of religious or moral beliefs including the unregulated practice of conscientious objection. Few studies have explored how providers in South Africa make sense of, or understand, conscientious objection in terms of refusing to provide abortion care services and the consequent impact on abortion access. Methods A qualitative approach was used which included 48 in-depth interviews with a purposively selected population of abortion related health service providers, managers and policy influentials in the Western Cape Province, South Africa. Data were analyzed using a thematic analysis approach. Results The ways in which conscientious objection was interpreted and practiced, and its impact on abortion service provision was explored. In most public sector facilities there was a general lack of understanding concerning the circumstances in which health care providers were entitled to invoke their right to refuse to provide, or assist in abortion services. Providers seemed to have poor understandings of how conscientious objection was to be implemented, but were also constrained in that there were few guidelines or systems in place to guide them in the process. Conclusions Exploring the ways in which conscientious objection was interpreted and applied by differing levels of health care workers in relation to abortion provision raised multiple and contradictory issues. From providers’ accounts it was often difficult to distinguish what constituted confusion with regards to the specifics of how conscientious objection was to be implemented in terms of the Choice on Termination of Pregnancy Act, and what was refusal of abortion care based on opposition to abortion in general. In order to disentangle what is resistance to abortion provision in general, and what is conscientious objection on religious or moral grounds, clear guidelines need to be provided including what measures need to be undertaken in order to lodge one’s right to conscientious objection. This would facilitate long term contingency plans for overall abortion service provision.
- ItemOpen AccessContraceptive needs and fertility intentions of women with breast cancer in Cape Town, South Africa: a qualitative study(2020-10-06) Harries, Jane; Constant, Deborah; Cairncross, Lydia; Moodley, JenniferBackground: No known studies have been undertaken in South Africa exploring the contraceptive and fertility needs and preferences of women of reproductive age (18–49) diagnosed with breast cancer. This study set out to understand the contraceptive needs and fertility intentions of women with breast cancer in Cape Town, South Africa. Methods Qualitative in-depth interviews were conducted with 24 women diagnosed with breast cancer and 4 health care providers at a tertiary hospital in Cape Town, South Africa. We explored contraceptive use prior to diagnosis; the impact of breast cancer on future fertility intentions and contraceptive use; understanding of suitable contraceptive methods during and after treatment and women’s fertility related counseling needs during their continuum of care. Data were analysed using a thematic analysis approach. Results Since being diagnosed with breast cancer, of those women using a contraceptive method, the non-hormonal intrauterine device (IUD) was the most commonly used method. However, women reported receiving limited information from health care providers about contraceptive use and future fertility planning post treatment when fertility desires might change. Many women reported limited information received from healthcare providers about the impact of cancer treatment on their future fertility. Most women did not receive information around fertility preservation options, and few were familiar with the concept. Providers focus was more on preventing pregnancy during treatment and ensuring a patient was on a non-hormonal contraceptive method. Providers supported a more holistic, multidisciplinary approach to breast cancer patient’s contraceptive and future fertility needs. Conclusions Limited contraceptive and future fertility counseling were reported by women despite many women being provided with the IUD. There is a need for improved information and counseling regarding the impact of treatment on contraceptive and fertility options. It is important that cancer care providers provide timely information regarding fertility options and communicate with patients about their fertility concerns prior to treatment and throughout the course of survivorship. The development of evidence-based information tools to enhance patient-provider communication and counseling could address knowledge gaps.
- ItemOpen AccessDelays in seeking an abortion until the second trimester: a qualitative study in South Africa(BioMed Central Ltd, 2007) Harries, Jane; Orner, Phyllis; Gabriel, Mosotho; Mitchell, EllenBACKGROUND:Despite changes to the South African abortion legislation in 1996, barriers to women accessing abortions still exist. Second trimester abortions, an inherently more risky procedure, continue to be 20% of all abortions. Understanding the reasons why women delay seeking an abortion until the second trimester is important for informing interventions to reduce the proportion of second trimester abortions in South Africa. METHODS: Qualitative research methods were used to collect data. Twenty-seven in-depth interviews were conducted in 2006 with women seeking a second trimester abortion at one public sector tertiary hospital and two NGO health care facilities in the greater Cape Town area, South Africa. Data were analysed using a grounded theory approach. RESULTS: Almost all women described multiple and interrelated factors that influenced the timing of seeking an abortion. Reasons why women delayed seeking an abortion were complex and were linked to changes in personal circumstances often leading to indecision, delays in detecting a pregnancy and health service related barriers that hindered access to abortion services. CONCLUSION: Understanding the complex reasons why women delay seeking an abortion until the second trimester can inform health care interventions aimed at reducing the proportion of second trimester abortions in South Africa.
- ItemOpen AccessExpanding contraceptive options for PMTCT clients: a mixed methods implementation study in Cape Town, South Africa(2014-01-10) Hoke, Theresa; Harries, Jane; Crede, Sarah; Green, Mackenzie; Constant, Deborah; Petruney, Tricia; Moodley, JenniferAbstract Background Clients of prevention of mother-to-child transmission (PMTCT) services in South Africa who use contraception following childbirth rely primarily on short-acting methods like condoms, pills, and injectables, even when they desire no future pregnancies. Evidence is needed on strategies for expanding contraceptive options for postpartum PMTCT clients to include long-acting and permanent methods. Methods We examined the process of expanding contraceptive options in five health centers in Cape Town providing services to HIV-positive women. Maternal/child health service providers received training and coaching to strengthen contraceptive counseling for postpartum women, including PMTCT clients. Training and supplies were introduced to strengthen intrauterine device (IUD) services, and referral mechanisms for female sterilization were reinforced. We conducted interviews with separate samples of postpartum PMTCT clients (265 pre-intervention and 266 post-intervention) to assess knowledge and behaviors regarding postpartum contraception. The process of implementing the intervention was evaluated through systematic documentation and interpretation using an intervention tracking tool. In-depth interviews with providers who participated in study-sponsored training were conducted to assess their attitudes toward and experiences with promoting voluntary contraceptive services to HIV-positive clients. Results Following the intervention, 6% of interviewed PMTCT clients had the desired knowledge about the IUD and 23% had the desired knowledge about female sterilization. At both pre- and post-intervention, 7% of clients were sterilized and IUD use was negligible; by comparison, 75% of clients used injectables. Intervention tracking and in-depth interviews with providers revealed intervention shortcomings and health system constraints explaining the failure to produce intended effects. Conclusions The intervention failed to improve PMTCT clients’ knowledge about the IUD and sterilization or to increase use of those methods. To address the family planning needs of postpartum PMTCT clients in a way that is consistent with their fertility desires, services must expand the range of contraceptive options to include long-acting and permanent methods. In turn, to ensure consistent access to high quality family planning services that are effectively linked to HIV services, attention must also be focused on resolving underlying health system constraints weakening health service delivery more generally.
- ItemOpen AccessAn exploratory study of what happens to women who are denied abortions in Cape Town, South Africa(BioMed Central, 2015-03-21) Harries, Jane; Gerdts, Caitlin; Momberg, Mariette; Greene Foster, DianaBackground: Despite the change in legal status of abortion in South Africa in 1996, barriers to access remain. Stigma associated with abortion provision and care, privacy concerns, and negative provider attitudes often discourage women from seeking legal abortion services and sometimes force women outside of the legal system. What happens when women present for abortion at a designated abortion facility and are denied abortions due to gestational limits or other factors–is unknown. Whether women seek care at referral facilities, seek illegal abortion, or carry pregnancies to term has never been documented. This study, part of a multi-country Global Turnaway Study, explored the experiences of women after denial of legal abortion services. Methods: Qualitative research methods were used to collect data at two non-governmental organization health care facilities providing abortion services. In depth interviews were held with women 2 to 3 months after they were denied an abortion. Data were analyzed using a thematic analysis approach. Results: The most common reason for being turned away was due to gestational age over 12 weeks with some women denied abortions that day because they did not have enough money to pay for the procedure. Almost all women were extremely upset at being denied an abortion on the day that they visited the health care facility. Some women were so distressed that they openly discussed the option of seeking an illegal provider or exploring the possibility of securing another health care professional who would assist them. Conclusions: Despite South Africa’s liberal abortion law and the relatively widespread availability of abortion services in urban settings, women in South Africa are denied abortion services largely due to being beyond the legal limits to obtain an abortion. A high proportion of women who were initially denied an abortion at legal facilities went on to seek options for pregnancy termination outside of the legal system through internet searches--some of which could have led to unsafe abortion practices. Further efforts should be directed towards informing women in all communities about the availability of free services in the public sector and educating them about the dangers of unsafe methods of pregnancy termination.
- ItemOpen AccessExploring motivation to notify and barriers to partner notification of sexually transmitted infections in South Africa(2017) Wood, Julia M; Harries, Jane; Mathews, CatherineObjectives: This article will review qualitative data from intervention-based counselling sessions to explore barriers to partner notification for men and women who have contracted sexually transmitted infections (STIs) in a township community in South Africa. It will further assess the intervention's impact on participants' motivation and skills to notify their partners about their STI status. Methods: Relying on recorded counselling sessions from an intervention run by a parent study, this substudy reviewed 30 transcripts from enhanced counselling sessions with 15 men and 15 women. Participants were adults between the ages of 19-41 (mean age = 28.4) who live within the catchment area of a South African township. Recordings were chosen based on verbal responsiveness of the participant and were manually coded for analysis. In addition, two programme counsellors were interviewed to enhance rigour and to reduce potential bias. Results: By the conclusion of the intervention session, both male and female participants were motivated to notify their partners face-to-face about their positive STI status. Despite this, misperceptions about the etiology and transmission of STIs, as well as inadequate support from the clinical level and power imbalances amongst men and women emerged as major barriers for the prevention of future STIs. Conclusions: While the intervention appears to be successful in facilitating partners' intentions to notify, the data shows significant social and structural barriers that will create difficulties for the prevention of future STIs. Participants' persistent concerns about acquiring HIV or their current positive status affect decision-making and therefore, could be a window of opportunity for health-care providers or lay counsellors to discuss STIs in high prevalence areas.
- ItemOpen AccessExploring motivation to notify and barriers to partner notification of sexually transmitted infections in South Africa: a qualitative study(BioMed Central, 2018-08-06) Wood, Julia M; Harries, Jane; Kalichman, Moira; Kalichman, Seth; Nkoko, Koena; Mathews, CatherineBackground This article will review qualitative data from intervention-based counselling sessions to explore barriers to partner notification (PN) for South African men and women who have contracted sexually transmitted infections (STIs). This qualitative study took place in a township where there is high STI and HIV prevalence. In addition to reviewing barriers to PN, the study will also identify participants’ perceptions about effective PN strategies that are presented during the intervention. Ultimately, the study will assess the intervention’s impact on participants’ motivation and skills to notify their partners about their STI status. Methods Relying on recorded counselling sessions from an intervention run by a parent study, this sub- study reviewed 30 transcripts from counselling sessions with 15 men and 15 women. The intervention was a 60 min interactive session where STI and HIV education, risk mitigation, and effective PN strategies were discussed. Participants were between 19 and 41 years old (mean age = 28.4) and lived within the catchment area of a South African township. Recordings were chosen based on verbal responsiveness of the participant and were manually coded for analysis. In addition, two programme counsellors were interviewed about their perceptions of the intervention and their experiences with participants to enhance rigour and reduce potential bias. Results By the conclusion of the intervention session, both male and female participants were motivated to notify their partners face-to-face about their positive STI status. Despite this, misperceptions about the etiology and transmission of STIs, as well as inadequate support from the clinical level and power imbalances amongst men and women emerged as major barriers for the prevention of future STIs. Conclusions While the intervention appears to be successful in facilitating partners’ intentions to notify, the data shows significant social and structural barriers that will create difficulties for the prevention of future STIs. Participants’ persistent concerns about acquiring HIV or their current positive status affect decision-making and therefore, could be a window of opportunity for health-care providers or lay counsellors to discuss STIs in high prevalence areas.
- ItemOpen AccessFactors impacting knowledge and use of long acting and permanent contraceptive methods by postpartum HIV positive and negative women in Cape Town, South Africa: a cross-sectional study(BioMed Central Ltd, 2012) Credé, Sarah; Hoke, Theresa; Constant, Deborah; Green, Mackenzie; Moodley, Jennifer; Harries, JaneBACKGROUND: The prevention of unintended pregnancies among HIV positive women is a neglected strategy in the fight against HIV/AIDS. Women who want to avoid unintended pregnancies can do this by using a modern contraceptive method. Contraceptive choice, in particular the use of long acting and permanent methods (LAPMs), is poorly understood among HIV-positive women. This study aimed to compare factors that influence women's choice in contraception and women's knowledge and attitudes towards the IUD and female sterilization by HIV-status in a high HIV prevalence setting, Cape Town, South Africa. METHODS: A quantitative cross-sectional survey was conducted using an interviewer-administered questionnaire amongst 265 HIV positive and 273 HIV-negative postpartum women in Cape Town. Contraceptive use, reproductive history and the future fertility intentions of postpartum women were compared using chi-squared tests, Wilcoxon rank-sum and Fisher's exact tests where appropriate. Women's knowledge and attitudes towards long acting and permanent methods as well as factors that influence women's choice in contraception were examined. RESULTS: The majority of women reported that their most recent pregnancy was unplanned (61.6% HIV positive and 63.2% HIV negative). Current use of contraception was high with no difference by HIV status (89.8% HIV positive and 89% HIV negative). Most women were using short acting methods, primarily the 3-monthly injectable (Depo Provera). Method convenience and health care provider recommendations were found to most commonly influence method choice. A small percentage of women (6.44%) were using long acting and permanent methods, all of whom were using sterilization; however, it was found that poor knowledge regarding LAPMs is likely to be contributing to the poor uptake of these methods. CONCLUSIONS: Improving contraceptive counselling to include LAPM and strengthening services for these methods are warranted in this setting for all women regardless of HIV status. These study results confirm that strategies focusing on increasing users' knowledge about LAPM are needed to encourage uptake of these methods and to meet women's needs for an expanded range of contraceptives which will aid in preventing unintended pregnancies. Given that HIV positive women were found to be more favourable to future use of the IUD it is possible that there may be more uptake of the IUD amongst these women.
- ItemOpen AccessA gendered perspective of a community's perception of microbicide introduction(2005) Harries, Jane; Orner, Phyllis; Cooper, DiSouth Africa is currently experiencing one of the worst HIV/AIDS epidemics in the world. The epidemic features distinctive age and gender distributions, with young women at greatest risk, and overall proportionally more women affected than men. Current HIV prevention strategies are limited as women's risk is frequently derived from their partners' behaviours rather than their own. The development of a microbicide for HIV prevention may offer the possibility of reducing women’s risk of infection in situations where other more effective methods cannot be used. An environment conducive to introducing a microbicide is critical to avoid some of the obstacles that have historically inhibited similar technological innovations. This study, which formed part of a larger qualitative research project, explored local sexual practices as they related to a female-initiated intra-vaginal product and the broader gender and sexual relations that underpin perceptions around possible microbicide use. An understanding of gender related factors is crucial in exploring women's access and ability to use a microbicide. Twenty-two focus groups and 11 in-depth interviews were held with community participants who resided in Langa, Cape Town. Data was analyzed using a grounded theory approach. Respondents expressed keen support for microbicides, underscored by desperation related to the AIDS epidemic and recognition of women's greater risk. Discussions amongst both women and men around microbicide use revealed numerous ways in which a new preventive technology could impact on broader gender relations. Issues around condom use, partner communication, meanings attributed to changes in vaginal moisture levels, covert use, potential for partner discord, and gender-based violence were linked by respondents to the varying ways in which the microbicide could impact on their daily lives. While the microbicide has the potential to "empower" women, inequitable gender relations and other social and economic problems will need to be addressed in order to halt the spread of the AIDS epidemic in South Africa.
- ItemOpen AccessHealth care providers' attitudes towards termination of pregnancy: A qualitative study in South Africa(BioMed Central Ltd, 2009) Harries, Jane; Stinson, Kathryn; Orner, PhyllisBACKGROUND:Despite changes to the abortion legislation in South Africa in 1996, barriers to women accessing abortion services still exist including provider opposition to abortions and a shortage of trained and willing abortion care providers. The dearth of abortion providers undermines the availability of safe, legal abortion, and has serious implications for women's access to abortion services and health service planning.In South Africa, little is known about the personal and professional attitudes of individuals who are currently working in abortion service provision. Exploring the factors which determine health care providers' involvement or disengagement in abortion services may facilitate improvement in the planning and provision of future services. METHODS: Qualitative research methods were used to collect data. Thirty four in-depth interviews and one focus group discussion were conducted during 2006 and 2007 with health care providers who were involved in a range of abortion provision in the Western Cape Province, South Africa. Data were analysed using a thematic analysis approach. RESULTS: Complex patterns of service delivery were prevalent throughout many of the health care facilities, and fragmented levels of service provision operated in order to accommodate health care providers' willingness to be involved in different aspects of abortion provision. Related to this was the need expressed by many providers for dedicated, stand-alone abortion clinics thereby creating a more supportive environment for both clients and providers. Almost all providers were concerned about the numerous difficulties women faced in seeking an abortion and their general quality of care. An overriding concern was poor pre and post abortion counselling including contraceptive counselling and provision. CONCLUSION: This is the first known qualitative study undertaken in South Africa exploring providers' attitudes towards abortion and adds to the body of information addressing the barriers to safe abortion services. In order to sustain a pool of abortion providers, programmes which both attract prospective abortion providers, and retain existing providers, needs to be developed and financial compensation for abortion care providers needs to be considered.
- ItemOpen AccessHIV/AIDS clients and their caregivers' perceptions of a community home-based care support programme in Botswana : a qualitative study(2006) Diseko, Agnes Nkeba; Harries, Jane; Orner, PhyllisThe study was undertaken at a village called Ramotswa in Botswana. Botswana is a small country in Southern Africa with a population of 1.7 million people (Botswana Housing and Population Census, 2001). The study explores HIV/AIDS clients' and caregivers' perceptions of the Community Home-Based Care support programme. The people involved in the community home-based care programme included nurses, family welfare educators (FWEs), social workers, community volunteers, and drivers. An exploratory qualitative design was used. Collection of data was through in-depth interviews, as well as a focus-group discussion. The sample was obtained through purposeful sampling, and there were nine HIV/AIDS clients, and seven caregivers who participated in the study. Results of the study were analysed themeativally. Resulst showed that many caregivers are women, and that they perform the task of care-giving under very difficult situations of poverty, social isolation, fear and stigma. They needed financial, material spiritual, as well as professional support from the home-based care team and community members.
- ItemOpen Access"If I could properly understand and get the right information...": The sexual and reproductive health needs and rights of women newly diagnosed with HIV: A qualitative study in the Western Cape Province South Africa(2009) Cooper, Sara; Harries, JaneWomen of reproductive age in South Africa are disproportionately affected by HIV, and represent the fastest growing group diagnosed with the virus. Despite this epidemiological picture, very little attention has been placed on the sexual and reproductive health needs of these women, particularly in South Africa, and other developing countries. This study, a sub-study of a much bigger study, explored the sexual and reproductive health needs of women newly diagnosed with HIV, and how these translate into their human rights. In-depth interviews, within qualitative methodologies, were conducted and analyzed with fourteen women from Gugulethu, Cape Town, who screened HIV-positive during enrolment or who seroconverted during the course of the larger microbicide, Carraguard study carried out by the Population Council and University of Cape Town. This study is novel in its exploration of these issues amongst women who are newly diagnosed and who were recruited outside of a health-care setting.