Consensus statement: Supporting Safer Conception and Pregnancy For Men And Women Living with and Affected by HIV

Abstract

Safer conception interventions reduce HIV incidence while supporting the reproductive goals of people living with or affected by HIV. We developed a consensus statement to address demand, summarize science, identify information gaps, outline research and policy priorities, and advocate for safer conception services. This statement emerged from a process incorporating consultation from meetings, literature, and key stakeholders. Three co-authors developed an outline which was discussed and modified with co-authors, working group members, and additional clinical, policy, and community experts in safer conception, HIV, and fertility. Co-authors and working group members developed and approved the final manuscript. Consensus across themes of demand, safer conception strategies, and implementation were identified. There is demand for safer conception services. Access is limited by stigma towards PLWH having children and limits to provider knowledge. Efficacy, effectiveness, safety, and acceptability data support a range of safer conception strategies including ART, PrEP, limiting condomless sex to peak fertility, home insemination, male circumcision, STI treatment, couples-based HIV testing, semen processing, and fertility care. Lack of guidelines and training limit implementation. Key outstanding questions within each theme are identified. Consumer demand, scientific data, and global goals to reduce HIV incidence support safer conception service implementation. We recommend that providers offer services to HIV-affected men and women, and program administrators integrate safer conception care into HIV and reproductive health programs. Answers to outstanding questions will refine services but should not hinder steps to empower people to adopt safer conception strategies to meet reproductive goals.

Implementation of a comprehensive safer conception intervention for HIV‐serodiscordant couples in Kenya: uptake, use and effectiveness

“…In conclusion, this pilot of a comprehensive safer conception intervention effectively eliminated sexual HIV transmission and demonstrated high uptake of combination safer conception strategies, with preferences for strategies that are already available in public settings in sub-Saharan Africa. These findings reinforce international calls to scale-up programmatic delivery of safer conception services as a package intervention that promotes counselling on fertility desires and emphasizes the utility of ART, PrEP and timed condomless sex for safer conception [30]. Public health priorities include advancing the integration of safer conception counselling and services into existing healthcare programmes, engaging communities to promote acceptability of pregnancy among people affected by HIV, and expanding the number of service providers that are empowered to encourage discussion of pregnancy desires with HIV-affected individuals and couples.…”

A Systematic Review of the Current Status of Safer Conception Strategies for HIV Affected Heterosexual Couples in Sub-Saharan Africa

“…While HIV affected couples were generally eager to learn more about safer conception [27, 36, 39, 44, 46, 48, 51, 54, 72–74], there are numerous barriers to SCS access including stigma around HIV-affected couples wanting and bearing children [46]. Like our review, a recent consensus statement supporting safer conception and pregnancy for couples living with HIV found that access to SCS is limited by stigma toward HIV affected couples having children and that this stigma limits provision of safer conception services [75]. Increasing community education about SCSs via community health worker networks may help increase acceptability for previously unfamiliar conception strategies and reduce community-, provider-, or family-level stigma around pregnancy in HIV affected couples, as was accomplished with increasing community knowledge and acceptance of HIV testing [76, 77] and couples’ HIV counseling and testing [78–80].…”

Prevalence and factors associated with fertility desires/intentions among individuals in HIV‐serodiscordant relationships: a systematic review of empirical studies

“…Serodiscordant couples face the unique challenge of minimizing the risk of HIV transmission to both the uninfected partner and any offspring . Nevertheless, many safer conception strategies currently exist that may be compatible with their fertility desires/intentions . One important strategy has been the uptake of antiretroviral therapy (ART) to suppress HIV viraemia.…”