“If I don’t use a condom … I would be stressed in my heart that I’ve done something wrong”: Routine Prevention Messages Preclude Safer Conception Counseling for HIV-Infected Men and Women in South Africa

L. T. Matthews, L. Moore, C. Milford, R. Greener, F. N. Mosery, R. Rifkin, C. Psaros, Steven Safren, A. Harrison, I. B. Wilson, D. R. Bangsberg, J. A. Smit

Research output: Contribution to journalArticle

16 Scopus citations


Intended conception likely contributes to a significant proportion of new HIV infections in South Africa. Safer conception strategies require healthcare provider–client communication about fertility intentions, periconception risks, and options to modify those risks. We conducted in-depth interviews with 35 HIV-infected men and women accessing care in South Africa to explore barriers and promoters to patient–provider communication around fertility desires and intentions. Few participants had discussed personal fertility goals with providers. Discussions about pregnancy focused on maternal and child health, not sexual HIV transmission; no participants had received tailored safer conception advice. Although participants welcomed safer conception counseling, barriers to client-initiated discussions included narrowly focused prevention messages and perceptions that periconception transmission risk is not modifiable. Supporting providers to assess clients’ fertility intentions and offer appropriate advice, and public health campaigns that address sexual HIV transmission in the context of conception may improve awareness of and access to safer conception strategies.

Original languageEnglish (US)
Pages (from-to)1666-1675
Number of pages10
JournalAIDS and Behavior
Issue number9
StatePublished - Feb 26 2015
Externally publishedYes



  • Client–provider communication
  • HIV prevention
  • Safer conception
  • South Africa

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases
  • Social Psychology

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