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Approximately 1400 HIV-positive women are known to become pregnant in the UK each year, the overwhelming majority being from Sub-Saharan Africa. The overall question I pose in this thesis is: how do African women living with HIV in the UK engage with HIV services and interventions during and after pregnancy? The question is addressed through a mixed methods approach. Drawing upon epidemiological data from the UK and Ireland's National Study of HIV in Pregnancy and Childhood, and primary ethnographic data, I examine key outcomes (not receiving antiretroviral therapy during pregnancy, detectable maternal HIV viral load at delivery, vertical transmission, late antenatal booking and maternal loss to follow-up from HIV care after pregnancy), as well as exploring women's experiences. Women from Western Africa and those who had arrived in the UK after conception appeared to be at greater risk of poorer outcomes. Pentecostal beliefs in divine healing, although cited by professionals as a potential barrier to HIV care, did not necessarily prevent women from engaging with HIV services and interventions. Instead, a complex constellation of cultural and structural factors including stigma and lack of UK citizenship rights emerged as a greater challenge to engagement with care. Women described good relationships with their multidisciplinary HIV antenatal teams that fostered confidence in medical systems. On the other hand, some reported negative experiences, particularly with regards to poor maternity care at the time of delivery and difficulties in abstaining from breastfeeding. Overall I found that the majority of African women living with HIV in the UK engage well with HIV services and interventions during and after pregnancy, resulting in low rates of both vertical transmission and loss to follow-up after pregnancy. This highlights women's resilience and determination to engage with HIV care, despite challenges, in order to secure the health of their babies.

Improving the implementation of family planning through integration with HIV services is vital to reduce maternal and child morbidity and mortality that has been a concern especially in developing countries like Ethiopia (UNFPA 2016). The aim of this study was to develop a strategic plan that could facilitate the implementation of an integrated family planning and HIV services at the public health centre level. The researcher utilized an explanatory sequential mixed method design with quantitative data collected in the first phase and qualitative data collected in the second phase. Data were collected from 403 clients in face-to-face structured interviews and from 305 service providers by means of a self-administered questionnaire. Descriptive analysis was applied to describe the findings of the study. Significance testing between variables was computed by odds ratio, p-value and 95% confidence interval. Bivariate and multi-variate logistic regressions were used for the analysis. In Phase 1, awareness of family planning methods, male involvement, marital status, client satisfaction, family income, waiting time, training, awareness of policies/guideline and transport availability were statistically significant challenges identified by clients and service providers. The client and service provider respondents identified previous use of family planning, men’s involvement, client satisfaction, availability of behavioural change communication materials, accessibility, budget, infrastructure and medical resources as opportunities. In phase 2, the researcher utilized the nominal group technique (NGT) to collect qualitative data from programme officers. Twenty-four programme officers from 10 sub city health offices, city and national level participated in two nominal groups, consisting of 12 participants each. Multiple group analysis was used to analyse the data from the nominal groups. The five strategies ranked as the most important were leadership and management; capacity building; implementation of policies and guidelines; advocacy/awareness, and infrastructure. The findings in phase 1 and phase 2 formed the basis for the development of a strategic plan using the process planning model. The strategic plan was developed and validated with the active participation and involvement of programme officers. The plan is intended to be implemented by service providers and programme officers to facilitate the implementation of integrated family planning and HIV services at the public health centre level. / Health Studies / D. Litt et. Phil. (Health Studies)

Disclosure of a Human Immunodeficiency Virus (HIV) positive status is vital for prevention and promotion of the couple‟s health. The study aimed to investigate the perceived barriers of pregnant women diagnosed as HIV positive towards disclosure of their HIV status to their partners in the Capricorn District, Limpopo Province. Recommendations were formulated to enhance the self-efficacy. A quantitative, explorative, descriptive cross-sectional design and the Health Belief Model theory was used. Non-probability, convenience sampling utilised and 170 respondents aged 18-40 years participated in the study. A questionnaire was used to collect data and the SSPS version 24.0 was utilised to analyse data. Overall, 87.64% respondents received disclosure education and 80% disclosed their status to their partners. Reasons for non-disclosure included fear of rejection, violent behaviour, blame and stigmatisation by partners. Health care workers should provide pregnant women with information on preventive strategies to enhance disclosure of HIV status. / Health Studies / M.A. (Nursing Science)

The purpose of this research study is to determine the factors influencing reproductive health choices of women living with HIV attending primary health care services. The need for this research study is evident in that most women attending health care services at primary health care clinics, and who are HIV positive report unintended pregnancy. The study sought to provide answers to factors influencing their reproductive choices. A quantitative, descriptive and cross-sectional research study was used in this study. The sample consisted of 83 females between the ages of 18 and 40. The findings of the research study provided the researcher with adequate evidence on the factors influencing reproductive health choices of women living with HIV attending primary health care services. The approach to reproductive health services was still acceptable but needs to be improved. Moreover, the identified factors therefore influenced one’s perceptions on reproductive health decisions among HIV-infected women. / Health Studies / M.A. (Public Health)