Relationship, partner factors and stigma are associated with safer conception information, motivation, and behavioral skills among women living with HIV in Botswana

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dc.contributor.authorGutin, Sarah A
dc.contributor.authorHarper, Gary W
dc.contributor.authorMoshashane, Neo
dc.contributor.authorRamontshonyana, Kehumile
dc.contributor.authorStephenson, Rob
dc.contributor.authorShade, Starley B
dc.contributor.authorHarries, Jane
dc.contributor.authorMmeje, Okeoma
dc.contributor.authorRamogola-Masire, Doreen
dc.contributor.authorMorroni, Chelsea
dc.date.accessioned2021-12-14T12:07:38Z
dc.date.available2021-12-14T12:07:38Z
dc.date.issued2021-12-08
dc.date.updated2021-12-12T04:11:50Z
dc.description.abstractAbstract Background A significant proportion (20-59%) of people living with HIV in sub-Saharan Africa desire childbearing, are of reproductive age, and are in sero-different relationships (~50%). Thus it is plausible that some portion of new HIV transmissions are due to attempts to become pregnant. Safer conception (SC) methods that effectively reduce the risk of HIV transmission exist and can be made available in resource-constrained settings. Few studies in the region, and none in Botswana, have quantitatively examined the correlates of information, motivation, and behavioral skills for SC uptake. Methods We surveyed 356 women living with HIV from 6/2018 to 12/2018 at six public-sector health clinics in Gaborone, Botswana. Participants were 18-40 years old, not pregnant, and desired future children or were unsure about their childbearing plans. We examined correlates of SC information, motivation, and behavioral skills using nested linear regression models, adjusting for socio-demographic, interpersonal, and structural variables. Results Knowledge of SC methods varied widely. While some SC methods were well known (medical male circumcision by 83%, antiretroviral therapy for viral suppression by 64%), most other methods were known by less than 40% of participants. Our final models reveal that stigma as well as relationship and partner factors affect SC information, motivation, and behavioral skills. Both internalized childbearing stigma (ß=-0.50, 95%CI:-0.17, -0.02) and perceived community childbearing stigma were negatively associated with SC information (ß=-0.09, 95%CI:-0.80, -0.21). Anticipated (ß=-0.06, 95%CI:-0.12, -0.003) and internalized stigma (ß=-0.27, 95%CI:-0.44; -0.10) were associated with decreased SC motivation, while perceived community childbearing stigma was associated with increased SC motivation (ß=0.07, 95%CI:0.02, 0.11). Finally, internalized childbearing stigma was associated with decreased SC behavioral skills (ß=-0.80, 95%CI: -1.12, -0.47) while SC information (ß=0.24, 95%CI:0.12, 0.36), motivation (ß=0.36, 95%CI:0.15, 0.58), and perceived partner willingness to use SC (ß=0.47, 95%CI:0.36, 0.57) were positively associated with behavioral skills Conclusions Low SC method-specific information levels are concerning since almost half (47%) of the study participants reported they were in sero-different relationships and desired more children. Findings highlight the importance of addressing HIV stigma and partner dynamics in interventions to improve SC information, motivation, and behavioral skills.
dc.identifier.apacitationGutin, S. A., Harper, G. W., Moshashane, N., Ramontshonyana, K., Stephenson, R., Shade, S. B., ... Morroni, C. (2021). Relationship, partner factors and stigma are associated with safer conception information, motivation, and behavioral skills among women living with HIV in Botswana. <i>BMC Public Health</i>, 21(Article number: 2231), http://hdl.handle.net/11427/35467en_ZA
dc.identifier.chicagocitationGutin, Sarah A, Gary W Harper, Neo Moshashane, Kehumile Ramontshonyana, Rob Stephenson, Starley B Shade, Jane Harries, Okeoma Mmeje, Doreen Ramogola-Masire, and Chelsea Morroni "Relationship, partner factors and stigma are associated with safer conception information, motivation, and behavioral skills among women living with HIV in Botswana." <i>BMC Public Health</i> 21, Article number: 2231. (2021) http://hdl.handle.net/11427/35467en_ZA
dc.identifier.citationGutin, S.A., Harper, G.W., Moshashane, N., Ramontshonyana, K., Stephenson, R., Shade, S.B., Harries, J. & Mmeje, O. et al. 2021. Relationship, partner factors and stigma are associated with safer conception information, motivation, and behavioral skills among women living with HIV in Botswana. <i>BMC Public Health.</i> 21(Article number: 2231) http://hdl.handle.net/11427/35467en_ZA
dc.identifier.ris TY - Journal Article AU - Gutin, Sarah A AU - Harper, Gary W AU - Moshashane, Neo AU - Ramontshonyana, Kehumile AU - Stephenson, Rob AU - Shade, Starley B AU - Harries, Jane AU - Mmeje, Okeoma AU - Ramogola-Masire, Doreen AU - Morroni, Chelsea AB - Abstract Background A significant proportion (20-59%) of people living with HIV in sub-Saharan Africa desire childbearing, are of reproductive age, and are in sero-different relationships (~50%). Thus it is plausible that some portion of new HIV transmissions are due to attempts to become pregnant. Safer conception (SC) methods that effectively reduce the risk of HIV transmission exist and can be made available in resource-constrained settings. Few studies in the region, and none in Botswana, have quantitatively examined the correlates of information, motivation, and behavioral skills for SC uptake. Methods We surveyed 356 women living with HIV from 6/2018 to 12/2018 at six public-sector health clinics in Gaborone, Botswana. Participants were 18-40 years old, not pregnant, and desired future children or were unsure about their childbearing plans. We examined correlates of SC information, motivation, and behavioral skills using nested linear regression models, adjusting for socio-demographic, interpersonal, and structural variables. Results Knowledge of SC methods varied widely. While some SC methods were well known (medical male circumcision by 83%, antiretroviral therapy for viral suppression by 64%), most other methods were known by less than 40% of participants. Our final models reveal that stigma as well as relationship and partner factors affect SC information, motivation, and behavioral skills. Both internalized childbearing stigma (ß=-0.50, 95%CI:-0.17, -0.02) and perceived community childbearing stigma were negatively associated with SC information (ß=-0.09, 95%CI:-0.80, -0.21). Anticipated (ß=-0.06, 95%CI:-0.12, -0.003) and internalized stigma (ß=-0.27, 95%CI:-0.44; -0.10) were associated with decreased SC motivation, while perceived community childbearing stigma was associated with increased SC motivation (ß=0.07, 95%CI:0.02, 0.11). Finally, internalized childbearing stigma was associated with decreased SC behavioral skills (ß=-0.80, 95%CI: -1.12, -0.47) while SC information (ß=0.24, 95%CI:0.12, 0.36), motivation (ß=0.36, 95%CI:0.15, 0.58), and perceived partner willingness to use SC (ß=0.47, 95%CI:0.36, 0.57) were positively associated with behavioral skills Conclusions Low SC method-specific information levels are concerning since almost half (47%) of the study participants reported they were in sero-different relationships and desired more children. Findings highlight the importance of addressing HIV stigma and partner dynamics in interventions to improve SC information, motivation, and behavioral skills. DA - 2021-12-08 DB - OpenUCT DP - University of Cape Town IS - Article number: 2231 J1 - BMC Public Health KW - Safer conception KW - Botswana KW - Information-motivation-behavioral skills KW - HIV stigma LK - https://open.uct.ac.za PY - 2021 T1 - Relationship, partner factors and stigma are associated with safer conception information, motivation, and behavioral skills among women living with HIV in Botswana TI - Relationship, partner factors and stigma are associated with safer conception information, motivation, and behavioral skills among women living with HIV in Botswana UR - http://hdl.handle.net/11427/35467 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12889-021-12268-5
dc.identifier.urihttp://hdl.handle.net/11427/35467
dc.identifier.vancouvercitationGutin SA, Harper GW, Moshashane N, Ramontshonyana K, Stephenson R, Shade SB, et al. Relationship, partner factors and stigma are associated with safer conception information, motivation, and behavioral skills among women living with HIV in Botswana. BMC Public Health. 2021;21(Article number: 2231) http://hdl.handle.net/11427/35467.en_ZA
dc.language.rfc3066en
dc.publisherBioMed Central
dc.rights.holderThe Author(s)
dc.sourceBMC Public Health
dc.source.journalissueArticle number: 2231
dc.source.journalvolume21
dc.source.urihttps://bmcpublichealth.biomedcentral.com/
dc.subjectSafer conception
dc.subjectBotswana
dc.subjectInformation-motivation-behavioral skills
dc.subjectHIV stigma
dc.titleRelationship, partner factors and stigma are associated with safer conception information, motivation, and behavioral skills among women living with HIV in Botswana
dc.typeJournal Article
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