Fertility desires and preferences for safer conception strategies among people receiving care for HIV at a publicly-funded clinic in Seattle, WA

Abstract

Understanding fertility desires and preferences for HIV prevention among individuals living with HIV, including the potential use of pre-exposure prophylaxis (PrEP) by HIV uninfected partners, can inform the delivery of safer conception counselling to reduce the risk of HIV transmission during pregnancy attempts. Men and women, predominantly heterosexual, engaged in HIV care in Seattle, WA, self-administered a questionnaire and we abstracted antiretroviral therapy (ART) status and HIV viral levels from medical records. We summarized participants’ sexual behavior, fertility desires, and preferences for safer conception strategies and used log-binomial regression to identify demographic, sexual, and behavioral factors associated with perceived acceptability of PrEP for HIV uninfected partners during pregnancy attempts. 52% of the 150 participants were female and the mean age was 48 years (range 23–74). 94.7% of participants were using ART and 79.3% had HIV viral load < 40 copies/mL. 22.2% of men and 34.6% of women reported that a healthcare provider had initiated discussion about fertility desires. 28.7% of participants were reproductive-age and desired children. Among sexually active reproductive-age participants with fertility desires, 56.3% reported inconsistent condom use and 62.5% did not report using effective birth control. 74.4% of reproductive age participants with fertility desires perceived that PrEP would be acceptable to an HIV uninfected partner and there were no significant predictors of PrEP acceptability. Nearly one third of reproductive-aged individuals living with HIV expressed fertility desires, highlighting a need for safer conception counselling in this setting. PrEP and ART were favored safer conception strategies.

The Magnetic Couples Study: protocol for a mixed methods prospective cohort study of HIV-serodifferent heterosexual couples’ perspectives and use of pre-exposure prophylaxis (PrEP)

“…HIV transmission within heterosexual couples in which one partner is HIV-negative and the other is living with HIV-so-called HIVserodifferent couples-plays a key role in the global HIV pandemic, [1][2][3][4][5] with couple-linked seroconversions accounting for between 30% and 50% of new HIV infections. 4 6 7 In the USA, about one-in-four heterosexuals living with HIV has an established primary sexual partner who is HIV-negative; [8][9][10][11][12][13][14][15][16][17][18][19] and such 'mixed-status' or 'magnetic' couples account for up to half of all new HIV infections among heterosexuals nationally. 20 The risk of HIV transmission within serodifferent couples has been observed to vary widely, from 0% to 20% per annum, depending on the type Open access and frequency of sexual behaviour and use of prevention methods.…”