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Antenatal care presentation and engagement in the context of sex work: exploring barriers to care for sex worker mothers in South Africa

BACKGROUND: Late presentation combined with limited engagement in antenatal care (ANC) increases risk of vertical transmission among mothers living with HIV. Female sex workers (FSW) have more than four times greater burden of HIV than other women of reproductive age in South Africa and the majority...

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Autores principales: Parmley, Lauren, Rao, Amrita, Kose, Zamakayise, Lambert, Andy, Max, Ryan, Phaswana-Mafuya, Nancy, Mcingana, Mfezi, Hausler, Harry, Baral, Stefan, Schwartz, Sheree
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538548/
https://www.ncbi.nlm.nih.gov/pubmed/31138313
http://dx.doi.org/10.1186/s12978-019-0716-7
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author Parmley, Lauren
Rao, Amrita
Kose, Zamakayise
Lambert, Andy
Max, Ryan
Phaswana-Mafuya, Nancy
Mcingana, Mfezi
Hausler, Harry
Baral, Stefan
Schwartz, Sheree
author_facet Parmley, Lauren
Rao, Amrita
Kose, Zamakayise
Lambert, Andy
Max, Ryan
Phaswana-Mafuya, Nancy
Mcingana, Mfezi
Hausler, Harry
Baral, Stefan
Schwartz, Sheree
author_sort Parmley, Lauren
collection PubMed
description BACKGROUND: Late presentation combined with limited engagement in antenatal care (ANC) increases risk of vertical transmission among mothers living with HIV. Female sex workers (FSW) have more than four times greater burden of HIV than other women of reproductive age in South Africa and the majority of FSW are mothers. For mothers who sell sex and are at increased HIV acquisition risk, timely and routine ANC seeking is especially vital for prevention of vertical transmission. This study represents a mixed-methods study with FSW in Port Elizabeth, South Africa, to characterize factors influencing ANC seeking behaviors in a high HIV prevalence context. METHODS: FSW (n = 410) were recruited into a cross-sectional study through respondent-driven sampling between October 2014 and April 2015 and tested for HIV and pregnancy. A sub-sample of pregnant and postpartum women (n = 30) were invited to participate in in-depth interviews (IDIs) to explore their current or most recent pregnancy experiences. IDIs were coded using a modified grounded theory approach and descriptive analyses assessed the frequency of themes explored in the qualitative analysis among the quantitative sample. RESULTS: In the quantitative survey, 77% of FSW were mothers (313/410); of these, two-thirds were living with HIV (212/313) and 40% reported being on antiretroviral therapy (ART) (84/212). FSW in the qualitative sub-sample reported unintended pregnancies with clients due to inconsistent contraceptive use; many reported discovering their unintended pregnancies between 4 and 7 months of gestation. FSW attributed delayed ANC seeking and ART initiation in the second or third trimesters to late pregnancy detection. Other factors limiting engagement in ANC included substance and alcohol use and discontent with previous healthcare-related experiences. CONCLUSIONS: Late pregnancy discovery, primarily because pregnancies were unplanned, contributed to late ANC presentation and delayed ART initiation, increasing risks of vertical HIV transmission. Given limited ART coverage among participants, addressing the broader sexual and reproductive health and rights needs of mothers who sell sex has important implications for preventing vertical transmission of HIV. Integrating comprehensive family planning services into FSW programming, as well as providing active linkage to ANC services may reduce barriers to accessing timely ANC, decreasing risks of vertical transmission. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12978-019-0716-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-65385482019-06-03 Antenatal care presentation and engagement in the context of sex work: exploring barriers to care for sex worker mothers in South Africa Parmley, Lauren Rao, Amrita Kose, Zamakayise Lambert, Andy Max, Ryan Phaswana-Mafuya, Nancy Mcingana, Mfezi Hausler, Harry Baral, Stefan Schwartz, Sheree Reprod Health Research BACKGROUND: Late presentation combined with limited engagement in antenatal care (ANC) increases risk of vertical transmission among mothers living with HIV. Female sex workers (FSW) have more than four times greater burden of HIV than other women of reproductive age in South Africa and the majority of FSW are mothers. For mothers who sell sex and are at increased HIV acquisition risk, timely and routine ANC seeking is especially vital for prevention of vertical transmission. This study represents a mixed-methods study with FSW in Port Elizabeth, South Africa, to characterize factors influencing ANC seeking behaviors in a high HIV prevalence context. METHODS: FSW (n = 410) were recruited into a cross-sectional study through respondent-driven sampling between October 2014 and April 2015 and tested for HIV and pregnancy. A sub-sample of pregnant and postpartum women (n = 30) were invited to participate in in-depth interviews (IDIs) to explore their current or most recent pregnancy experiences. IDIs were coded using a modified grounded theory approach and descriptive analyses assessed the frequency of themes explored in the qualitative analysis among the quantitative sample. RESULTS: In the quantitative survey, 77% of FSW were mothers (313/410); of these, two-thirds were living with HIV (212/313) and 40% reported being on antiretroviral therapy (ART) (84/212). FSW in the qualitative sub-sample reported unintended pregnancies with clients due to inconsistent contraceptive use; many reported discovering their unintended pregnancies between 4 and 7 months of gestation. FSW attributed delayed ANC seeking and ART initiation in the second or third trimesters to late pregnancy detection. Other factors limiting engagement in ANC included substance and alcohol use and discontent with previous healthcare-related experiences. CONCLUSIONS: Late pregnancy discovery, primarily because pregnancies were unplanned, contributed to late ANC presentation and delayed ART initiation, increasing risks of vertical HIV transmission. Given limited ART coverage among participants, addressing the broader sexual and reproductive health and rights needs of mothers who sell sex has important implications for preventing vertical transmission of HIV. Integrating comprehensive family planning services into FSW programming, as well as providing active linkage to ANC services may reduce barriers to accessing timely ANC, decreasing risks of vertical transmission. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12978-019-0716-7) contains supplementary material, which is available to authorized users. BioMed Central 2019-05-29 /pmc/articles/PMC6538548/ /pubmed/31138313 http://dx.doi.org/10.1186/s12978-019-0716-7 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Parmley, Lauren
Rao, Amrita
Kose, Zamakayise
Lambert, Andy
Max, Ryan
Phaswana-Mafuya, Nancy
Mcingana, Mfezi
Hausler, Harry
Baral, Stefan
Schwartz, Sheree
Antenatal care presentation and engagement in the context of sex work: exploring barriers to care for sex worker mothers in South Africa
title Antenatal care presentation and engagement in the context of sex work: exploring barriers to care for sex worker mothers in South Africa
title_full Antenatal care presentation and engagement in the context of sex work: exploring barriers to care for sex worker mothers in South Africa
title_fullStr Antenatal care presentation and engagement in the context of sex work: exploring barriers to care for sex worker mothers in South Africa
title_full_unstemmed Antenatal care presentation and engagement in the context of sex work: exploring barriers to care for sex worker mothers in South Africa
title_short Antenatal care presentation and engagement in the context of sex work: exploring barriers to care for sex worker mothers in South Africa
title_sort antenatal care presentation and engagement in the context of sex work: exploring barriers to care for sex worker mothers in south africa
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538548/
https://www.ncbi.nlm.nih.gov/pubmed/31138313
http://dx.doi.org/10.1186/s12978-019-0716-7
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