Missed opportunities to address reproductive health care needs among HIV-infected women in antiretroviral therapy programmes

OBJECTIVES To investigate the delivery of reproductive health care services in an antiretroviral therapy (ART) programme in Cape Town, South Africa. METHODS A cross-sectional survey was conducted among 227 consecutive women attending a hospital-based ART outpatient service who had been on ART for at least one month. Semi-structured interviews investigating reproductive health issues and services received were conducted in participants' home language by a trained interviewer. RESULTS Sixty-seven per cent of the women were younger than 30 years and 75% were sexually active. The use of both condoms (70%) and hormonal contraceptives (31%) decreased with age, while the prevalence of sterilization (13%) increased with age. Few women knew about emergency contraception (EC) (7%) or termination of pregnancy (TOP) (13%). Approximately 45% of women had had a Papanicolau smear, and this was constant across all age groups. One in 10 women had experienced verbal or physical abuse by an intimate partner since their HIV diagnosis. More than 80% of women had discussed the use of condoms and other forms of contraception with a health care provider since their HIV diagnosis, but less than 5% had discussed EC or TOP, and no woman had discussed issues of partner violence. DISCUSSION These data delineate the large unmet need for reproductive health services among HIV-infected women receiving ART in this setting. While issues related to condom and contraceptive use are relatively well addressed, reproductive health services related to unintended pregnancy and partner violence appear to be neglected. The integration of a broad range of reproductive health services into ART programmes requires urgent attention in both research and policy-making circles.