Discussing reproductive goals with healthcare providers among women living with HIV in Canada: the role of provider gender and patient comfort,Sexual and Reproductive Health Matters

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Discussing reproductive goals with healthcare providers among women living with HIV in Canada: the role of provider gender and patient comfort
Sexual and Reproductive Health Matters ( IF 5.732 ) Pub Date : 2021-06-24 , DOI: 10.1080/26410397.2021.1932702
Lashanda Skerritt ₁ , Alexandra de Pokomandy ₂ , Nadia O'Brien ₃ , Nadia Sourial ₄ , Ann N Burchell ₅ , Gillian Bartlett ₆ , Tibor Schuster ₇ , Danielle Rouleau ₈ , Karène Proulx-Boucher ₉ , Neora Pick ₁₀ , Deborah Money ₁₁ , Rebecca Gormley ₁₂ , Allison Carter ₁₃ , Mark H Yudin ₁₄ , Mona Loutfy ₁₅ , Angela Kaida ₁₆ ,

Affiliation

PhD Candidate, Department of Family Medicine, McGill University, Montreal, QC, Canada.
Associate Professor, Department of Family Medicine, McGill University, Montreal QC, Canada; Clinician-Scientist, Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.
PhD Candidate, Department of Family Medicine, McGill University, Montreal, QC, Canada; Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.
Assistant Research Professor, Department of Family and Emergency Medicine, University of Montreal, Montreal, QC, Canada.
Associate Professor, Department of Family and Community Medicine and Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
Professor, Department of Family Medicine, McGill University, Montreal, QC, Canada.
Assistant Professor, Department of Family Medicine, McGill University, Montreal, QC, Canada.
Associate Professor, Department of Microbiology, Infection and Immunology, University of Montreal, Montreal, QC, Canada.
Research Coordinator, Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.
Medical Director, Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada; Clinical Professor, Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Professor, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Clinician-Scientist, Women's Health Research Institute, Vancouver, BC, Canada.
Research Coordinator, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
Research Fellow, Faculty of Medicine, Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
Associate Professor, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada.
Professor, Faculty of Medicine, University of Toronto, Toronto, Canada; Clinician-Scientist, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
Associate Professor and Canada Research Chair in Global Perspectives in HIV and Sexual and Reproductive Health, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada. Correspondence:

Abstract

Antiretroviral therapy effectively prevents sexual and vertical transmission of HIV. Yet, some women living with HIV report having unmet needs for reproductive health care. This study measured the prevalence of women discussing reproductive goals with any current healthcare provider and assessed the effect of the current HIV care provider’s gender on such discussions and whether comfort was a mediator. We analysed baseline and 18-month survey data from 533 women living with HIV enrolled in the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) (2013–2017), a community-based participatory study, restricting the analysis to participants aged 16–45 years. We used causal mediation analysis to estimate direct and indirect effects of the gender of one’s HIV care provider on reproductive discussions, incorporating mediating and interaction effects of women having any provider with whom they felt comfortable discussing reproductive goals. Between the baseline and 18-month follow-up surveys, 34.3% (183/533) of women discussed their reproductive goals with a healthcare provider. Having a woman HIV care provider was associated with a 1.18 excess relative risk (ERR) of discussion (95%CI: 0.15, 2.20). The mediating effect of comfort was primarily explained by the fact that those participants with women providers felt more comfortable discussing their reproductive goals compared to participants with men providers, accounting for 66% (95%CI: 32%, 99%) of the total effect. Findings support that HIV provider gender affects women’s comfort and whether they discuss reproductive goals, which must be acknowledged and addressed in care delivery.

中文翻译：

与加拿大艾滋病毒感染者的医疗保健提供者讨论生殖目标：提供者性别和患者舒适度的作用

摘要

抗逆转录病毒疗法可有效防止艾滋病毒的性传播和垂直传播。然而，一些感染艾滋病毒的妇女报告说，生殖保健需求未得到满足。该研究测量了与任何当前医疗保健提供者讨论生殖目标的女性的流行率，并评估了当前 HIV 护理提供者的性别对此类讨论的影响以及舒适度是否是中介因素。我们分析了加拿大 HIV 女性性与生殖健康队列研究 (CHIWOS) (2013–2017) 中 533 名感染 HIV 的女性的基线和 18 个月调查数据，这是一项基于社区的参与性研究，分析仅限于 16 岁的参与者–45 年。我们使用因果中介分析来估计一个人的 HIV 护理提供者的性别对生殖讨论的直接和间接影响，结合女性的中介和互动效应，如果她们愿意与任何提供者讨论生育目标。在基线和 18 个月的随访调查之间，34.3% (183/533) 的女性与医疗保健提供者讨论了她们的生殖目标。有一名女性 HIV 护理提供者与 1.18 的过度相对风险 (ERR) 相关 (95% CI: 0.15, 2.20)。舒适的中介效应主要是因为与男性提供者相比，女性提供者的参与者在讨论他们的生殖目标时更自在，占总效应的 66% (95%CI: 32%, 99%) . 调查结果支持艾滋病毒提供者的性别会影响女性的舒适度以及她们是否讨论生殖目标，在提供护理时必须承认和解决这些问题。

更新日期：2021-06-24

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