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.