"Nothing is ever going to change if we don't start advocating for our child.": Community-level disclosure and stigma management strategies among parents of internationally adopted children living with PHIV.

Background: The number of internationally adopted children living with perinatally-acquired HIV (IACP) in the U.S. is increasing, yet little is known about their families' experiences navigating HIV disclosure within a community context. This paper examines the lived experiences of adoptive parents as they navigate HIV disclosure and manage stigma toward their adopted children within their broader communities. Methods: A purposive sample of parents of IACP was recruited at two pediatric infectious disease clinics and via closed Facebook groups. Parents completed two semi-structured interviews approximately one year apart. Interview questions included strategies parents used to reduce the impact of community level stigma that their child is likely to encounter as they mature. Interviews were analyzed using Sort and Sift, Think and Shift analytic approach. All parents (n = 24) identified as white and most (n = 17) had interracial families, with children adopted from 11 different countries (range: age at adoption 1-15 years; range: age at first interview 2-19 years). Results: Analyses revealed that parents serve as advocates for their child by both supporting more public HIV disclosure at times, but also applying indirect strategies such as working to improve outdated sex education material. Knowledge of HIV disclosure laws empowered parents to make informed decisions about who, if anyone, in the community needed to know their child's HIV status. Conclusion: Families with IACP would benefit from HIV disclosure support/training and community-based HIV stigma reduction interventions.

An Exploratory Study of the Role of Birth Stories in Shaping Expectations for Childbirth among Nulliparous Black Women: Everybody is Different (but I'm Scared).

INTRODUCTION: Birth stories area source of information and vicarious experience for nulliparous women. Although health disparities research suggests that the childbirth experiences of Black women differ from those of white women, little research has been conducted about the nature of birth stories shared and their subsequent effect on expectations. METHODS: Pregnant nulliparous Black women were recruited from a women's health practice in the southeastern United States. Participants completed in-depth semistructured interviews about the birth stories they had previously heard and their thoughts about their own upcoming birth experiences. Interviews were audio-recorded and transcribed. Researchers applied the traditions of thematic analysis to identify emergent themes. RESULTS: Fourteen women participated in the study (mean age, 28 years). Women reported hearing birth stories from a variety of sources, most commonly mothers and friends. Stories heard generally included details about process, outcome, and social context that often acknowledged past racist hospital policies and experienced discrimination. Women were an active audience to birth stories and sought out stories from some sources, avoided stories from other sources, and used rhetorical strategies to mark stories as either more relatable or less relatable. Women's reported fears, expectations, and choices they planned to make reflected features of the birth stories that they had heard. DISCUSSION: Nulliparous women accessed and evaluated birth stories from others and applied knowledge received from those stories to their own experiences. Birth stories played an important role in shaping women's hopes, fears, expectations, and childbirth-related choices. Health care providers should inquire about the birth stories shared with their patients to gain a sense of their childbirth desires and expectations. An appreciation for the importance of knowledge learned from birth stories has the potential to reduce maternal health disparities by improving patient-provider communication through a shared understanding of the patient's goals and fears.

"After having a waterbirth, I feel like it's the only way people should deliver babies": The decision making process of women who plan a waterbirth.

OBJECTIVE: To explore the decision making process of women who seek to give birth in water DESIGN: A qualitative design using semi-structured interviews with women who planned a waterbirth was used. Interviews were recorded, transcribed, and coded for emergent themes using a grounded theory approach for analyses SETTING: Twenty-three women (mean age = 33.5 years mean number of children = 2.5) who had planned a waterbirth were recruited from a prenatal care clinic in a mid-sized southeastern city in the United States. Questions explored how they decided to pursue a waterbirth, sources of information, support systems, resistance, and their birth experience FINDINGS: Although all participants used the tub during labor, five did not give birth in the water. Analyses revealed that a belief in their body's ability to give birth along with the desire for limited medical interventions were the primary reasons for choosing waterbirth. Previous positive and negative experiences with birth also shaped their decision. Women actively sought information about waterbirths from the internet and friends. One-third of participants decided to pursue a waterbirth later in pregnancy and changed OB practices in order to have access to a waterbirth. Midwives and doulas were viewed as critical supporters of their waterbirth decision. However, most participants experienced some form of resistance toward their decision from others including family, friends, coworkers, and strangers. The overwhelming majority were positive about their experience and indicated they felt empowered, even if they were unable to give birth in the water, and encouraged other women to consider waterbirth. Most indicated they wanted to have a waterbirth in the future.

"I definitely want grandbabies": Caregivers of adolescents with perinatally-acquired HIV reflect on dating and childbearing.

INTRODUCTION: Parents and caregivers of typically developing teens are often a source of information about sexual health and relationships. However, little is known about the information offered to adolescents with perinatally acquired HIV (APHIV) by caregivers who may provide support and guidance to their teen as they explore sexuality and childbearing. METHOD: This qualitative exploratory study involved the in-depth interviews of 18 caregivers (17 females), including biological mothers (9), relatives (5), and adoptive/foster mothers (4), who care for APHIV. Interviews explored views regarding their adolescent's engagement in romantic relationships, sexual behaviors, and childbearing. The guardian's knowledge of mother-to-child-transmission (MTCT) was also assessed for accuracy. Transcribed interviews were coded for emergent themes. RESULTS: Analyses indicated that the majority of caregivers discussed sexual health and dating with their adolescent. However, guidance regarding disclosure to partners of the adolescent's HIV status varied. Some biological mothers and all relatives cautioned against disclosure, contrary to foster/adoptive mothers. Most caregivers wanted their adolescent to experience parenthood. Reasons affirming childbearing included the belief their child would be a good parent and wanted to experience parenthood, childbearing as a normative experience, and decreased HIV-related stigma. Biological mothers and most relatives did not know the risk of MTCT, as opposed to all foster/adoptive mothers who accurately stated the risk was 1% to 2%. DISCUSSION: The type of guardian influenced the nature of shared information related to disclosure and risk of MTCT. Sexual and reproductive health education should be provided to caregivers because they could be an important source of information for APHIV. (PsycINFO Database Record