Fertility care expectations: what do PLHIV and health care providers in Jamaica know about assisted reproduction services for safe conception?

Increased life expectancy among persons living with HIV (PLHIV) has increased the desire for parenthood. It is therefore important that PLHIV and health care providers (HCPs) are aware of the available assisted reproduction services (ARS) for PLHIV facing infertility or unsuppressed viremia. Through secondary data analysis we identified PLHIV who were actively trying to conceive and their knowledge of ARS. As specialized fertility care for PLHIV is managed by Obstetrician/Gynecologists (Ob/Gyns), they were surveyed regarding their attitudes towards working with PLHIV and their awareness and knowledge of ARS with a self-administered questionnaire. In this cross-sectional study, 251 PLHIV and 102 Ob/Gyns were recruited and interviewed using a semi-structured questionnaire. Although most Ob/Gyns (81%) reported being supportive of PLHIV having children, 85% counseled against pregnancy, particularly persons in HIV serodifferent relationships. Significantly more PLHIV under 40 years compared to those over 40 years had heard about ARS (59% vs. 43%, p = .007). Ob/Gyns were more knowledgeable of expensive ARS, while PLHIV's knowledge was more restricted to cheaper more accessible ones. In conclusion Ob/Gyns knowledge gaps and underlying stereotypes may present barriers to PLHIV's uptake of ARS. Additionally, virologically unsuppresed persons in HIV serodifferent relationships may be vulnerable as Ob/Gyns were less supportive of them.

Jamaican mothers' influences of adolescent girls' sexual beliefs and behaviors.

PURPOSE: The purpose of this study was to identify the ways in which urban Jamaican mothers influence their adolescent daughters' sexual beliefs and behaviors in order to incorporate them into the design of a family-based human immunodeficiency virus (HIV) risk reduction intervention program. DESIGN: Focus groups were conducted with 46 14- to 18-year-old adolescent girls and 30 mothers or female guardians of adolescent girls recruited from community-based organizations in and around Kingston and St. Andrew, Jamaica. Separate focus groups were held with mothers and daughters; each included 6 to 10 participants. Focus group sessions were scripted, led by teams that included trained Jamaican and American facilitators and note-takers, and audio-taped to ensure data accuracy. Data were analyzed using qualitative content analysis. FINDINGS: Four major maternal influences were identified: mother-daughter relationship quality, mother-daughter sexual communication, monitoring or supervision, and maternal sexual role modeling. Mothers' and daughters' reports were consistent; both groups identified positive and negative influences within each category. CONCLUSIONS: Some maternal influences were positive and health promoting; others were negative and promoted unsafe sexual activity and risk for HIV and other sexually transmitted infections. These influences were incorporated into the design of a culture-specific family-based HIV risk reduction intervention tailored to the needs of urban Jamaican adolescent girls and their mothers. CLINICAL RELEVANCE: In order to be effective, family-based HIV risk reduction interventions should be theory based and tailored to the target audience. The four maternal influences identified in this formative study were incorporated into the subsequent intervention design.

A survey of providers' knowledge, opinions, and practices regarding induced abortion in Jamaica.

OBJECTIVE: To determine the stance of providers in Jamaica regarding the suggested change in abortion law and proposal to train providers. METHODS: A face-to-face anonymous survey of 35 obstetrician-gynecologists (Obs) and 228 general practitioners (GPs) in Kingston was used to assess knowledge, opinions and practice. RESULTS: Demand for abortion was high: 94.7% of GPs and 100% of Obs had been asked to perform an abortion. Although 50.7% of GPs and 70.6% of Obs had performed abortions, 81.2% and 88.6%, respectively, had referred women to another provider. Training was more likely for Obs (65.7% versus 52.2%; P<0.001). Patient assessment was appropriate, but written guidelines, counseling, and social services referral were uncommon. More Obs knew the laws (62.9% versus 42.5%; P=0.052). Most participants did not agree to abortion under any circumstance, but only 25.3% had moral or religious objections, and only 9.4% refused to perform abortions because they were illegal. Most providers felt that abortions should be made more accessible, and almost all felt that abortions should be performed only by Obs. CONCLUSION: Demand for abortions is high in Jamaica, but many doctors refer clients to another provider. Patient assessment is good, but support services need improvement.

A concept of Caribbean fatherhood

OBJECTIVE: To investigate the manner in which Jamaican men view themselves and their relationships with women and their role in family life as partners and fathers. METHODS: A two-stage stratified random sample was used to select men aged 15-40 years in three parishes, Kingston, St.Andrew and Hanover. Enumeration districts and dwellings were selected in the first and second stages, respectively. In selected dwellings, all males 15-40 years were identified among the eligible males who had fathered at least one child. From these, one respondent was randomly selected. A questionnaire was administered to the sample yield of 714. Focus group discussions were held with a subset of the sample. Eight focus groups were held, four each in rural and urban areas among men 15-24 years, and similarly among men 25-40 years. RESULTS: The majority (64 percent) of the men who currently either in visiting or common-law unions and 23 percent had formed these unions between the ages of 15 and 19 years. Most (58 percent) had spent one to six years in their current union, of which the largest group (26 percent) spent one and a half to three years. Just over two-thirds of the children were born in current unions and those born outside of the current union were born in visiting unions (41 percent). Approximately 44 percent of the respondents' children were not living with them; 80 percent were living with their mothers. Respondents (87 percent) reported that they were involved in their children's lives. Major involvement was the provision of food (52 percent), clothes (51 percent) and health care (51 percent). The main obstacle identified for male participation in parenting was their marginal economic status. Significant relationships (p<0.1) were: the increase in the fathering role with age; fathers who were not household heads were less involved in their children's lives, especially when a step-father was present and the economic contribution of fathers was strongly related to their economic status. Contact between parents was significantly influenced by the age of both the father and the children. CONCLUSIONS: The findings indicate that fatherhood is hinged in the ability of the men to make economic and material contributions to their family. In general, men wanted a better life for their children but faced real constraints. Poverty was the major factor preventing men from performing the role they consider central to their concept of fatherhood. (AU)

Children and women: special health and social problems related to substance abuse

The prevalence of substance abuse among 1187 women, 15-50 years, in a national sample and 1074 children 10-18 years in eight schools in Jamaica, using a modified Drug Use Screening Inventory (DUSI) questionnaire are used to indicate the likely health and social problems that may result. Painkillers (48.4 percent) were the most popular substances used by children followed by alcohol (36.9 percent) and painkillers (39.2 percent). In both samples inhalants and marijuana by rank are the most popular illicit substances used. Inhalant use was 1.9 percent for women and 9.0 percent for children in a ratio of 1:5 and marijuana 2.8 percent and 2.5 percent respectively. Cocaine/crack use is 50 percent more among children (1.0 percent) compared to women (0,5 percent). LSD-25 use was only reported by children (0.2 percent). Women under 20 years in the national sample, by rank, were the heaviest users of inhalants (52.2 percent), marijuana (30.0 percent), painkillers (24.4 percent) and alcohol (23.0 percent). Differences in use of tranquilizers (p=0.0008) and inhalants (p=0.008) were statistically significant for women among the age groups under 20 years, 20-24, 25-29, 30-34 and 35 and over. Among children differences by age for substances used were insignificant. Drug involvement evidence reported by children were withdrawal symptoms 10.4 percent, 16.9 percent playing drinking games at parties and 8.9 percent having a craving or strong desire for alcohol or drugs, corresponding proportions for women were 3.3 percent, 0.1 percent and 0.1 percent. Psychosocial factors in both samples which correlated strongly with drug use were behaviour patterns, behavioural disorders, social competence and family system. Substance use and its effects on health are reflected in reported health problems. Children (43.1 percent) reported too much or too little sleep and 25-29 percent reported weight change of 10 pounds or more, abdominal pain and nausea, trouble with breathing and coughing and deficient energy. Corresponding proportions for women reporting similar problems were 15-17 percent. The paper discusses the likely impact of drug use on the health and social well being of women and children and the size of the problem in relation to the proportions reporting use. (AU)

Fostering collaboration between researchers and non-governmental organizations on women and AIDS in Jamaica

Reports findings of a study of researchers and community-based NGOs in Jamaica and a forum held to build stronger bonds between persons from the two groups. Presents the objectives of the project which were to: document and analyze research efforts on women and AIDS and the program experiences of NGOs with the aim of identifying progress in research and successful interventions that could be replicated in other settings; identify the lessons learned from existing collaborations between the research and action communities; conduct a forum in which researchers and NGOs could share their experiences and needs, as well as to identify ways to strengthen communication and collaboration. In addition disseminate to researchers, NGOs, policy makers, and donors at the national and international level, the findings from analyzing the progress in research and program experience, as well as the lessons learned from the collaborative process. Suggests the need for: training and educating women and men about HIV/AIDS; collaboration among NGOs, churches and public institutions; a central pool of research findings and materials; more research; and more funding for more programs(AU)

Partner support for female contraceptive use

The study of partner support for female contraceptive use was conducted in February 1989. This cross-sectional study focussed on the social and demographic variables of women who are currently users and non-users of contraceptives. The variables included education, occupation, age and fertility and their relationship to the level, intensity and quality of partner support they received from their male partners. The study sought to determine communication between the partners and the level of approval for contraceptive use, content of communication and the experience of side-effects. Partner support for contraceptive use in the study was generally low. Practical support from the men to promote continuous method use being low. There is, however, a higher level of approval given by the men for contraceptive use. The experience of side-effects from contraceptive methods, although not experienced by the majority has serious consequences for creating unmet needs for contraceptives among those so affected. There is the need to develop relevant and accessible family planning services for men, while expanding those already in place for women, to address the new and ongoing issues in family planning (AU)