The Effectiveness of Sexual and Reproductive Health Counselling Services for HIV Positive Women in Comprehensive Care Centres in Langata, Kenya

Abstract

ABSTRACT In Kenya, women living with HIV account for 52%of the 1.5million people living with HIV. With advent of Antiretroviral Therapy (ART), many HIV positive women have become pregnant intentionally or unintentionally. In 2009, 81,000 women living with HIV became pregnant where between 6% and 35% of pregnancies were unintended. In the same year, there were approximately 22,000 children living with HIV produced. Without any intervention, a third of these childrenwould die by the first birthday and half by the second birthday. For over eight years, Kenya has been trying out four models of Sexual and Reproductive Health (SRH)/HIV integration innovations that is through; (i) stand-alone family planning clinics and antenatal clinics, (ii) through STI screening clinics, (iii) through HIV counselling and testing sites and (iv) through HIV care and treatment centres. There was however a limited evidence onthe extent to which health workers and counselors implement effective SRH counseling services within the Comprehensive Care Centres (CCCs) to prevent unintended pregnancies and also reduce the risk for acquiring STIs.This case control study was carried out on HIV positive women (71 cases and 71 controls) agedbetween 18 and 49 years. A case was defined as an HIV positive woman, aged 18-49 years that became pregnant and had attended the CCC for antenatal services between January and December of 2013 at the selected health facility for not less than three times. Both cases and controls were selected on the basis of having been exposed or not exposed to SRH counseling to ascertain itseffectiveness to preventunintended pregnancies and STIs among them. Quantitative andqualitative methods of data collection and analysis were utilized using chi squares (at p=0.001 and 0.05) and odds ratios were used to analyze the relationships among variables. The study also explored factors that promote or hinder the utilization of SRH counseling information and services provided to women living with HIV at the CCCs in Langata. The findings show a close match for demographical data amongst the cases and controls in terms of the age, education level, period and frequency for accessing SRH service with HIV diagnosis with women aged 30-39 years seeking the SRH counselling services more among the cases and controls as compared to other age groups. Among the cases, all HIV positive women were equally and likely to get unintended pregnancies irrespective of whether they had received SRH counselling or not (odds ratios [OR]: 1.114; 95% confidence interval [CI]: 0.427–2.911). The study further reveals that SRH counselling had no significant impact in supporting the HIV positive women to reduce the risks factors of unintended pregnancies, it even strongly lacked enough information to empower HIV positive women to prevent STIs.There were notable factors impacting on the use and uptake of SRH counselling services such as stigma and discrimination, lack of follow-up, financial and logistical challenges to access the health facility, the long queues at the facility to mention among others. This calls for a review of the SRH counselling process, more training for SRH counsellors on effective SRH counselling; more mentorship and constant support supervision to uphold the counselling proficiencyin SRH.