Exploring fertility decisions among pregnant HIV-positive women on antiretroviral therapy at a health centre in Balaka, Malawi: A descriptive qualitative.

BACKGROUND: The proportions of women of reproductive age living with the human immunodeficiency virus (HIV) vary between different regions of the world, with significantly higher proportions in sub-Saharan Africa. Family planning is one of the major issues that couples and families affected with HIV must confront. We aimed to assess the cultural and social factors associated with childbearing and family planning knowledge, decision-making, and practices among HIV-positive pregnant women attending antenatal clinic at a health centre in Balaka, Malawi. METHODS: This was a qualitative descriptive study carried out at Kalembo Health Centre in Balaka. A purposive sampling technique was used to select pregnant women enroled in the antiretroviral therapy (ART) programme. A sample size of thirty-five women was decided upon after data saturation. Qualitative inquiry was used during data collection. Data were analysed using systematic text condensation, while numbers and percentages were generated using Microsoft Excel. RESULTS: Out of 35 participants, 20 were aged between 25 and 34 years, and 18 had been married at least three times. All 35 women wished to have their own biological child. Factors, reported by participants, that promote childbearing included: the desire to please their husbands, fear of losing their husbands to others if they did not bear children, the knowledge that ART would help prevent their children from acquiring the virus, the desire to prove to others that they can also bear children, and a lack of family planning leading to unplanned pregnancies. CONCLUSIONS: The factors that lead to pregnancies among women on ART in Balaka ranged from assured safety of the child from HIV, lack of contraception, to other factors related to their partners. The authors recognize and support the freedom for women to become pregnant and bear children, and, in the context of HIV infection, fertility and reproductive services should include a comprehensive approach towards addressing issues of HIV and AIDS and childbearing among infected women.

Counsellors' experience during training and home based HIV counselling and testing in Zomba District, Malawi.

INTRODUCTION: In 2007, St Luke's Mission Hospital initiated a district-wide Door to Door HIV counselling and testing (HCT) programme in Zomba district. The intent of the programme was to provide quality HCT services to people in their homes and effectively those found to be HIV positive referred to appropriate services. METHODOLOGY: This was a cross sectional study using a questionnaire consecutively administered to a sample of 105 counsellors who had resided in the community for a period of over one year. The questionnaire sought to establish, knowledge gained, experiences and recommendations on how the programme has been implemented and assist running of similar future programmes. Data analysis was done manually using both qualitative and quantitative methodologies. RESULTS: We report that nearly 23% of the counsellors thought that during their training as a door to door HCT counselor they had benefited in learning to working with communities; an aspect they found to be highly applicable in discharge of their duties. The major setbacks during the training were lack daily allowances, less amount of time spent on understanding child counselling and the manual used was difficult to follow. Over 32% of the counsellors were satisfied with the participation of their clients during pre-test counselling sessions, however, the major challenge they had was the misconception that they were blood suckers, a view reported by nearly 17% of the counsellors. Close to 72% reported not to have met any problems during post-test counselling compared to 24% who reported to have found challenges. CONCLUSION: The study has revealed that there is a need to re-look child children counselling especially in training door to door HCT counsellors. It has also revealed a prevalent allowance culture despite the benefits of training. The common challenges were refusal of test results and failure to understand discordance. Misconceptions may still exist in the community regarding anything dealing with removing blood. There is still need for more information regarding discordance especially among couples in the community.