{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:41:31Z","timestamp":1792802491107,"version":"4.5.0"},"reference-count":58,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T00:00:00Z","timestamp":1606780800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006801","name":"Horace H. Rackham School of Graduate Studies, University of Michigan","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006801","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Department of Health Behavior and Health Education, University of Michigan"},{"name":"Center for the Education of Women (CEW+), University of Michigan","id":[{"id":"https:\/\/ror.org\/00jmfr291","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Population Studies Center, University of Michigan","id":[{"id":"https:\/\/ror.org\/00jmfr291","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Institute for Social Research, University of Michigan","id":[{"id":"https:\/\/ror.org\/00jmfr291","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["T32 HD007339"],"award-info":[{"award-number":["T32 HD007339"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institutes of Mental Health","doi-asserted-by":"crossref","award":["T32 MH19105"],"award-info":[{"award-number":["T32 MH19105"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Various safer conception methods to limit HIV transmission risks can be offered in resource-constrained settings. However, implementation of safer conception services remains limited in many countries, including Botswana. Understanding perceptions about safer conception methods and the benefits and challenges to use can help with the development of policies, interventions, and service delivery models. Forty-five women living with HIV in the greater Gaborone, Botswana area participated in focus group discussions. Themes were analyzed using interpretive phenomenology. Despite low knowledge of specific safer conception methods that can be used to prevent transmission of HIV when trying to achieve pregnancy, there was noted interest in pre-exposure prophylaxis and vaginal insemination. Challenges to greater uptake were noted including a lack of knowledge about a range of SC methods, limited partner support and communication, provider stigma, health systems barriers, current policies, and the cultural acceptability of methods. Interventions will need to address these challenges and be responsive to the needs and reflect the realities of WLHIV who desire pregnancy in order for safer conception uptake to become a common practice.<\/jats:p>","DOI":"10.1371\/journal.pone.0242992","type":"journal-article","created":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T16:00:41Z","timestamp":1606838441000},"page":"e0242992","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["\u201cI did not know about all these\u201d: Perceptions regarding safer conception methods by women living with HIV in Gaborone, Botswana"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7634-1296","authenticated-orcid":true,"given":"Sarah A.","family":"Gutin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary W.","family":"Harper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neo","family":"Moshashane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kehumile","family":"Ramontshonyana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atlang","family":"Mompe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul J.","family":"Fleming","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7359-8419","authenticated-orcid":true,"given":"Jane","family":"Harries","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doreen","family":"Ramogola-Masire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chelsea","family":"Morroni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,12,1]]},"reference":[{"key":"pone.0242992.ref001","unstructured":"UNAIDS. Global HIV and AIDS statistics\u20142018 fact sheet. 2018. http:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/UNAIDS_FactSheet_en.pdf."},{"key":"pone.0242992.ref002","first-page":"67","article-title":"Fertility Desires and Intentions among HIV-Positive Women during the Post-natal period in Uganda","volume":"18","author":"SA Gutin","year":"2014","journal-title":"Afr J Reprod Health"},{"key":"pone.0242992.ref003","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12978-015-0004-0","article-title":"Provider attitudes about childbearing and knowledge of safer conception at two HIV clinics in Malawi","volume":"12","author":"P Kawale","year":"2015","journal-title":"Reprod Health"},{"key":"pone.0242992.ref004","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1080\/09540121.2011.647114","article-title":"Fertility desires and family planning demand among HIV-positive clients in follow-up care at antiretroviral treatment unit in Gondar university hospital, Ethiopia","volume":"7","author":"L Tesfaye","year":"2012","journal-title":"Vulnerable Child Youth Stud"},{"key":"pone.0242992.ref005","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1080\/09540121.2014.911808","article-title":"My intention was a child but I was very afraid: fertility intentions and HIV risk perceptions among HIV-serodiscordant couples experiencing pregnancy","volume":"26","author":"K Ngure","year":"2014","journal-title":"Kenya. AIDS Care"},{"key":"pone.0242992.ref006","doi-asserted-by":"crossref","first-page":"2183","DOI":"10.1016\/S0140-6736(08)60953-8","article-title":"New heterosexually transmitted HIV infections in married or cohabiting couples in urban Zambia and Rwanda: an analysis of survey and clinical data","volume":"371","author":"KL Dunkle","year":"2008","journal-title":"Lancet"},{"key":"pone.0242992.ref007","doi-asserted-by":"crossref","first-page":"430","DOI":"10.2174\/157016210793499303","article-title":"Preventing HIV transmission in married and cohabiting HIV-discordant couples in sub-Saharan Africa through combination prevention","volume":"8","author":"J Matovu","year":"2010","journal-title":"Curr HIV Res"},{"key":"pone.0242992.ref008","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1186\/1471-2458-10-247","article-title":"My partner wants a child: a cross-sectional study of the determinants of the desire for children among mutually disclosed sero-discordant couples receiving care in Uganda","volume":"10","author":"J Beyeza-Kashesya","year":"2010","journal-title":"BMC Public Health"},{"key":"pone.0242992.ref009","first-page":"2","article-title":"The dilemma of safe sex and having children: challenges facing HIV sero-discordant couples in Uganda","volume":"9","author":"J Beyeza-Kashesya","year":"2009","journal-title":"Afr Health Sci"},{"key":"pone.0242992.ref010","volume-title":"Guidance on couples HIV testing and counselling including antiretroviral therapy for treatment and prevention in serodiscordant couples: recommendations for a public health approach","author":"World Health Organization","year":"2012"},{"key":"pone.0242992.ref011","doi-asserted-by":"crossref","first-page":"31","DOI":"10.4102\/sajhivmed.v12i2.196","article-title":"Guideline on safer conception in fertile HIV-infected individuals and couples","author":"L-G Bekker","year":"2011","journal-title":"South Afr J HIV Med"},{"key":"pone.0242992.ref012","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.1097\/QAD.0b013e32834a36d0","article-title":"Preexposure prophylaxis and timed intercourse for HIV-discordant couples willing to conceive a child","volume":"25","author":"PL Vernazza","year":"2011","journal-title":"AIDS"},{"key":"pone.0242992.ref013","doi-asserted-by":"crossref","DOI":"10.1155\/2012\/587651","article-title":"Evaluating safer conception options for HIV-serodiscordant couples (HIV-infected female\/HIV-uninfected male): A closer look at vaginal insemination","volume":"2012","author":"O Mmeje","year":"2012","journal-title":"Infect Dis Obstet Gynecol"},{"key":"pone.0242992.ref014","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1056\/NEJMoa1105243","article-title":"Prevention of HIV-1 infection with early antiretroviral therapy","volume":"365","author":"MS Cohen","year":"2011","journal-title":"N Engl J Med"},{"key":"pone.0242992.ref015","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1016\/S0140-6736(10)60705-2","article-title":"Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis","volume":"375","author":"D Donnell","year":"2010","journal-title":"Lancet"},{"key":"pone.0242992.ref016","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1126\/science.1193748","article-title":"Effectiveness and Safety of Tenofovir Gel, an antiretroviral microbicide, for the prevention of HIV Infection in women","volume":"329","author":"QA Karim","year":"2010","journal-title":"Science (80-)"},{"key":"pone.0242992.ref017","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1056\/NEJMoa1108524","article-title":"Antiretroviral prophylaxis for HIV prevention in heterosexual men and women","volume":"367","author":"JM Baeten","year":"2012","journal-title":"N Engl J Med"},{"key":"pone.0242992.ref018","doi-asserted-by":"crossref","first-page":"2587","DOI":"10.1056\/NEJMoa1011205","article-title":"Preexposure chemoprophylaxis for HIV prevention in men who have sex with men","volume":"363","author":"RM Grant","year":"2010","journal-title":"N Engl J Med"},{"key":"pone.0242992.ref019","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1371\/journal.pmed.0020298","article-title":"Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 trial","volume":"2","author":"B Auvert","year":"2005","journal-title":"PLoS Med"},{"key":"pone.0242992.ref020","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/S0140-6736(07)60313-4","article-title":"Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial","volume":"369","author":"RH Gray","year":"2007","journal-title":"Lancet"},{"key":"pone.0242992.ref021","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1080\/09540121.2014.946385","article-title":"Achieving pregnancy safely: perspectives on timed vaginal insemination among HIV-serodiscordant couples and health-care providers in Kisumu, Kenya","volume":"27","author":"O Mmeje","year":"2015","journal-title":"AIDS Care"},{"key":"pone.0242992.ref022","doi-asserted-by":"crossref","first-page":"43","DOI":"10.7448\/IAS.20.2.21291","article-title":"Client uptake of safer conception strategies: implementation outcomes from the Sakh\u2019umndeni Safer Conception Clinic in South Africa","volume":"20","author":"SR Schwartz","year":"2017","journal-title":"J Int AIDS Soc"},{"key":"pone.0242992.ref023","doi-asserted-by":"crossref","first-page":"2479","DOI":"10.1007\/s10461-017-1732-7","article-title":"Prevalence and Correlates of Use of Safer Conception Methods in a Prospective Cohort of Ugandan HIV-Affected Couples with Fertility Intentions","volume":"21","author":"GJ Wagner","year":"2017","journal-title":"AIDS Behav"},{"key":"pone.0242992.ref024","unstructured":"UNAIDS. Botswana Country Factsheet 2019. 2019. http:\/\/www.unaids.org\/en\/regionscountries\/countries\/botswana. Accessed 31 May 2019."},{"key":"pone.0242992.ref025","first-page":"1","article-title":"Unintended pregnancy, contraceptive use, and childbearing desires among HIV-infected and HIV-uninfected women in Botswana: a cross-sectional study","volume":"16","author":"GK Mayondi","year":"2016","journal-title":"BMC Public Health"},{"key":"pone.0242992.ref026","unstructured":"Government of Botswana. Botswana Second Generation HIV Antenatal Sentinel Serveillance Technical Report, 2011. Gaborone, Botswana; 2011."},{"key":"pone.0242992.ref027","first-page":"221","article-title":"Botswana\u2019s progress toward achieving the 2020 UNAIDS 90-90-90 antiretroviral therapy and virological suppression goals: A population-based survey","author":"T Gaolathe","year":"2017","journal-title":"Lancet HIV"},{"key":"pone.0242992.ref028","unstructured":"PrEPWatch. Botswana: A snapshot of PrEP scale-up, registration and resources for Botswana. 2020."},{"key":"pone.0242992.ref029","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1177\/0956462415604091","article-title":"Acceptability and preferences for safer conception HIV prevention strategies: a qualitative study","volume":"27","author":"SR Schwartz","year":"2016","journal-title":"Int J STD AIDS"},{"key":"pone.0242992.ref030","first-page":"29","volume-title":"Handbook of HIV Prevention","author":"JD Fisher","year":"2000"},{"key":"pone.0242992.ref031","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1111\/j.1365-2648.2008.04922.x","article-title":"The phenomenological focus group: an oxymoron?","volume":"2007","author":"C Bradbury-Jones","year":"2009","journal-title":"J Adv Nurs"},{"key":"pone.0242992.ref032","first-page":"50","volume-title":"Establishing Access to, Making Contact with and Selecting Participants. In: Interviewing as Qualitative Research: A Guide for Researchers in Education","author":"I Seidman","year":"2006"},{"key":"pone.0242992.ref033","volume-title":"The Constructivist Credo","author":"YS Lincoln","year":"2013"},{"key":"pone.0242992.ref034","volume-title":"Interpretive phenomenological analysis: Theory, method and research","author":"JA Smith","year":"2009"},{"key":"pone.0242992.ref035","first-page":"121","volume-title":"APA Handbook of Sexuality and Psychology","author":"DM Frost","year":"2014"},{"key":"pone.0242992.ref036","first-page":"69","volume-title":"Qualitative Data Analysis: A Methods Sourcebook","author":"MB Miles","year":"2014"},{"key":"pone.0242992.ref037","unstructured":"Dedoose. Dedoose Version 7.5.16, web application for managing, analyzing, and presenting qualitative and mixed method research data. 2016. www.dedoose.com."},{"key":"pone.0242992.ref038","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.1007\/s10461-015-1026-x","article-title":"\u201cIf I don\u2019t use a condom \u2026 I would be stressed in my heart that I\u2019ve done something wrong\u201d: Routine Prevention Messages Preclude Safer Conception Counseling for HIV-Infected Men and Women in South Africa","volume":"19","author":"LT Matthews","year":"2015","journal-title":"AIDS Behav"},{"key":"pone.0242992.ref039","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1080\/09540121.2016.1153592","article-title":"Perspectives of healthcare providers and HIV-affected individuals and couples during the development of a Safer Conception Counseling Toolkit in Kenya: stigma, fears, and recommendations for the delivery of services","volume":"28","author":"O Mmeje","year":"2016","journal-title":"AIDS Care"},{"key":"pone.0242992.ref040","doi-asserted-by":"crossref","first-page":"2916","DOI":"10.1007\/s10461-018-2170-x","article-title":"A Systematic Review of the Current Status of Safer Conception Strategies for HIV Affected Heterosexual Couples in Sub- Saharan Africa","volume":"22","author":"D Joseph Davey","year":"2018","journal-title":"AIDS Behav"},{"key":"pone.0242992.ref041","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1007\/s10461-011-0068-y","article-title":"Reproductive decision-making and periconception practices among HIV-positive men and women attending HIV services in Durban, South Africa","volume":"17","author":"LT Matthews","year":"2013","journal-title":"AIDS Behav"},{"key":"pone.0242992.ref042","doi-asserted-by":"crossref","first-page":"40","DOI":"10.29063\/ajrh2016\/v20i1.4","article-title":"Multi-level Correlates of Safer Conception Methods Awareness and Attitudes among Ugandan HIV Clients with Fertility Intentions","volume":"20","author":"GJ Wagner","year":"2016","journal-title":"Afr J Reprod Health"},{"key":"pone.0242992.ref043","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1089\/apc.2015.0089","article-title":"Attitudes, Knowledge, and Correlates of Self-Efficacy for the Provision of Safer Conception Counseling Among Ugandan HIV Providers","volume":"29","author":"K Goggin","year":"2015","journal-title":"AIDS Patient Care STDS"},{"key":"pone.0242992.ref044","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2016\/4195762","article-title":"\u201cI Always Worry about What Might Happen Ahead\u201d: Implementing Safer Conception Services in the Current Environment of Reproductive Counseling for HIV-Affected Men and Women in Uganda","volume":"2016","author":"LT Matthews","year":"2016","journal-title":"Biomed Res Int"},{"key":"pone.0242992.ref045","doi-asserted-by":"crossref","first-page":"1","DOI":"10.7448\/IAS.17.1.18832","article-title":"Challenges with couples, serodiscordance and HIV disclosure: Healthcare provider perspectives on delivering safer conception services for HIV-affected couples, South Africa","volume":"17","author":"TL Crankshaw","year":"2014","journal-title":"J Int AIDS Soc"},{"key":"pone.0242992.ref046","doi-asserted-by":"crossref","first-page":"2488","DOI":"10.1007\/s10461-017-1816-4","article-title":"Safer Conception for Couples Affected by HIV: Structural and Cultural Considerations in the Delivery of Safer Conception Care in Uganda","volume":"21","author":"D Mindry","year":"2017","journal-title":"AIDS Behav"},{"key":"pone.0242992.ref047","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.socscimed.2008.03.042","article-title":"The relationship of acceptance or denial of HIV-status to antiretroviral adherence among adult HIV patients in urban Botswana","volume":"67","author":"SL Nam","year":"2008","journal-title":"Soc Sci Med"},{"key":"pone.0242992.ref048","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1111\/j.1547-5069.2009.01266.x","article-title":"Patients adherence to anti-retroviral therapy in Botswana","volume":"41","author":"E Kip","year":"2009","journal-title":"J Nurs Scholarsh"},{"key":"pone.0242992.ref049","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4102\/curationis.v38i1.1255","article-title":"Adherence to antiretroviral treatment by adults in a rural area of Botswana","volume":"38","author":"VJ Ehlers","year":"2015","journal-title":"Curationis"},{"key":"pone.0242992.ref050","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1080\/17290376.2014.972057","article-title":"The constraints of antiretroviral uptake in rural areas: the case of Thamaga and surrounding villages, Botswana","volume":"11","author":"M Bene","year":"2014","journal-title":"SAHARA J"},{"key":"pone.0242992.ref051","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1080\/07399330802662077","article-title":"People living with HIV and AIDS on the brink: stigma\u2014a complex sociocultural impediment in the fight against HIV and AIDS","volume":"30","author":"K Nthomang","year":"2009","journal-title":"Botswana. Health Care Women Int"},{"key":"pone.0242992.ref052","doi-asserted-by":"crossref","first-page":"e12","DOI":"10.1097\/QAI.0000000000000263","article-title":"\u201cWhat they wanted was to give birth; nothing else\u201d: barriers to retention in option B+ HIV care among postpartum women in South Africa","volume":"67","author":"K Clouse","year":"2014","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pone.0242992.ref053","doi-asserted-by":"crossref","first-page":"e106325","DOI":"10.1371\/journal.pone.0106325","article-title":"\u201cIt Is Like That, We Didn\u2019t Understand Each Other\u201d: Exploring the Influence of Patient-Provider Interactions on Prevention of Mother-To-Child Transmission of HIV Service Use in Rural Tanzania","volume":"9","author":"A Gourlay","year":"2014","journal-title":"PLoS One"},{"key":"pone.0242992.ref054","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12978-019-0751-4","article-title":"Perceptions of pregnancy occurring among HIV-serodiscordant couples in Kenya","volume":"16","author":"G Kimemia","year":"2019","journal-title":"Reprod Health"},{"key":"pone.0242992.ref055","volume-title":"Masa. Handbook of the Botswana Integrated HIV Clinical Care Guidelines","author":"MOH Botswana","year":"2016"},{"key":"pone.0242992.ref056","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-019-6904-0","article-title":"Integrating safer conception services into primary care: providers \u2018 perspectives","volume":"19","author":"MC Patwa","year":"2019","journal-title":"BMC Public Health"},{"key":"pone.0242992.ref057","doi-asserted-by":"crossref","first-page":"52","DOI":"10.7448\/IAS.20.2.21309","article-title":"Delivering safer conception services to HIV serodiscordant couples in Kenya: perspectives from healthcare providers and HIV serodiscordant couples","volume":"20","author":"K Ngure","year":"2017","journal-title":"J Int AIDS Soc"},{"key":"pone.0242992.ref058","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1080\/07399332.2014.924520","article-title":"\u201cI May Not Say We Really Have a Method, It Is Gambling Work\u201d: Knowledge and Acceptability of Safer Conception Methods Among Providers and HIV Clients in Uganda","volume":"35","author":"S Finocchario-Kessler","year":"2014","journal-title":"Health Care Women Int"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0242992","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T16:01:23Z","timestamp":1606838483000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0242992"}},"subtitle":[],"editor":[{"given":"Karine","family":"Dub\u00e9","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2020,12,1]]},"references-count":58,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,12,1]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0242992","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,1]]}}}