%0 Journal Article
%T A Social Ecological Approach to Exploring Barriers to Accessing Sexual and Reproductive Health Services among Couples Living with HIV in Southern Malawi
%A Belinda Chimphamba Gombachika
%A Heidi Fjeld
%A Ellen Chirwa
%A Johanne Sundby
%A Address Malata
%A Alfred Maluwa
%J ISRN Public Health
%D 2012
%R 10.5402/2012/825459
%X With wide access to antiretroviral therapy, people living with HIV are living longer. The reduction in the mother-to-child transmission of HIV has encouraged some people living with HIV to have children and remarry. However, some continue to have limited access to sexual and reproductive health services. The study explores barriers encountered by couples living with HIV in accessing sexual and reproductive health services using the social ecological model. Data were collected using in-depth interviews with twenty couples purposively sampled in matrilineal Chiradzulu and patrilineal Chikhwawa communities in Malawi from July to December 2010. Data were analyzed using framework analysis method. The study findings identify barriers across the five levels of the social ecological model indicating that the use of sexual and reproductive health services is influenced by diverse factors. We suggest three main areas for primary intervention: services must be located closer to their communities and integrated with existing antiretroviral services. In addition, information gatekeepers, both formal and informal, should be empowered with knowledge about sexual and reproductive health, including HIV and AIDS. Finally, there is a need to coordinate the flow of reproductive health, HIV, and AIDS information between Malawi Ministry of Health and formal and informal organizations. 1. Introduction HIV remains a challenge to public health in Africa. Recent data indicate that the rate of new HIV infections has decreased; for instance, in 33 countries, HIV incidence has fallen by more than 25% between 2001 and 2009 [1]. Of these countries, 22 are in Sub-Saharan Africa. However, there are still 22.5 million adults and children living with HIV. Heterosexual contact is the principal mode of transmission seconded by mother-to-child transmission of HIV [1]. With the advent of antiretroviral therapy (ART/ARV), worldwide health improvements have occurred over the last decades and the result has been a dramatic reduction in HIV-related morbidity and mortality, and improvements in quality of life [2¨C5]. HIV infection may now be considered a chronic illness because the ARVs suppress HIV replication thereby increasing CD4 cell count, delaying clinical progression of AIDS and prolonging survival [6]. Similarly, the number of people living with HIV (PLWH) is increasing due to decreased mortality because of ART [1]. Similar situations have been noted in earlier studies in developed countries such as France, Brazil, and the United States of America [5, 7, 8]. With a broader spectrum of
%U http://www.hindawi.com/journals/isrn.public.health/2012/825459/