Preconception and Contraceptive Care for Women Living with HIV

Abstract

Women living with HIV have fertility desires and intentions that are similar to those of uninfected women, and with advances in treatment most women can realistically plan to have and raise children to adulthood. Although HIV may have adverse effects on fertility, recent studies suggest that antiretroviral therapy may increase or restore fertility. Data indicate the increasing numbers of women living with HIV who are becoming pregnant, and that many pregnancies are unintended and contraception is underutilized, reflecting an unmet need for preconception care (PCC). In addition to the PCC appropriate for all women of reproductive age, women living with HIV require comprehensive, specialized care that addresses their unique needs. The goals of PCC for women living with HIV are to prevent unintended pregnancy, optimize maternal health prior to pregnancy, improve maternal and fetal outcomes in pregnancy, prevent perinatal HIV transmission, and prevent HIV transmission to an HIV-uninfected sexual partner when trying to conceive. This paper discusses the rationale for preconception counseling and care in the setting of HIV and reviews current literature relevant to the content and considerations in providing PCC for women living with HIV, with a primary focus on well-resourced settings.

HIV+ Men Need Reproductive Counseling Too: Assessing Childbearing Goals and Provider Communication Among HIV+ Male Patients in Rio de Janeiro, Brazil

“…[4][5][6] Recognizing the importance of having children among HIV + men, patients need to be able to discuss and plan such childbearing decision making with their HIV provider and partner. There is growing awareness of the unmet need for reproductive counseling among HIV + women in clinical care, as illustrated by recent studies in Brazil, 12,13 the United States, [14][15][16][17] and sub-Saharan Africa. 18,19 This same need for reproductive counseling among HIV + male patients has been largely ignored.…”

Preconception care for people living with HIV

“…Preconception care (PCC) for people living with HIV (PLWH) aims to promote planned pregnancies; support safer conception strategies for serodifferent or seroconcordant partners; prevent mother-to-child HIV transmission (PMTCT); and optimize maternal and infant health outcomes [1,2]. Although what PCC should encompass and why PCC is important are increasingly understood [2], a key question remains: how is PCC best implemented in both high-resource and low-resource settings?…”

“…Although what PCC should encompass and why PCC is important are increasingly understood [2], a key question remains: how is PCC best implemented in both high-resource and low-resource settings? Improving PCC implementation is critical, given estimates that the majority of HIV-positive women who want future biological children have not received reproductive counseling, largely due to lack of provider-initiated conversations [3][4][5][6].…”

“…outline components of PCC [1,2,7,8], and a few publications specifically describe the use of antiretroviral drugs as prevention for safer conception among serodifferent couples [9][10][11]. Guidelines for PCC among HIV-positive women have been recently released in both the United States and Canada [12][13][14][15].…”

“…Time constraints combined with competing priorities, knowledge gaps, and stigma may preclude HIV providers from providing comprehensive PCC [2]. One solution may include task sharing, whereby other healthcare providers assume clearly defined, appropriate roles for implementing different components of PCC (Table 2).…”