Sexual and reproductive health needs of young women living with perinatally acquired HIV

Abstract

Background Increasingly, young women living with perinatally acquired HIV (YWLPaHIV) have transitioned from paediatric to adult services. There remains a paucity of data on the sexual and reproductive health (SRH) needs of YWLPaHIV and their access to youth-friendly care. Amidst healthcare changes due to COVID-19 pandemic restrictions, we explored SRH needs of a cohort of YWLPaHIV. Methods Evaluation of SRH needs of YWLPaHIV attending a UK NHS-youth HIV service with data collected from patient records and self-reported questionnaires amongst women attending between July and November 2020 following easing of the first lockdown and reintroduction of in-person appointments. Results 71 of 112 YWLPaHIV registered at the clinic completed questionnaires during the study period and were included in the analysis. Median age was 23 y (IQR 21–27, range 18–36). 51/71(72%) reported coitarche, average age 17.6 y (IQR 16–18, range 14–24). 24 women reported 47 pregnancies resulting in 16 (34%) HIV-negative live-births, 19 (40%) terminations, 9(19%) miscarriages, with 3 pregnancies ongoing. 31/48(65%) sexually active women reported current contraception: 10 (32%) condoms, 19 (62%) long-acting, and 3(10%) oral contraceptive pill. 18/51(35%) reported a previous sexually transmitted infection; human papillomavirus (HPV) (11), Chlamydia trachomatis (9) and herpes simplex (2). 27/71(38%) women had undergone cervical cytology including 20/28(71%) women aged ≥25 y with abnormalities documented in 29%. HPV vaccination was reported in 83%, with protective hepatitis B titres in 71%. Conclusion High rates of unplanned pregnancy, STIs and cervical abnormalities highlight the continuing SRH needs of YWLPaHIV and requirement for open access to integrated HIV/SRH services despite pandemic restrictions.

Adults with Perinatally Acquired HIV; Emerging Clinical Outcomes and Data Gaps

“…Rates of any contraception use have been reported in up to 65% of young women LWPaHIV [ 119 ], with condom use reported in 20–30% [ 119 , 120 , 121 ]. In a recent UK study of women with LWPaHIV, 34% reported a previous pregnancy; 40% resulted in termination and 19% in miscarriage [ 119 ], with rates of termination being higher in this cohort of people LWPaHIV when compared to a US cohort of all women with HIV [ 122 ].…”

“…Rates of any contraception use have been reported in up to 65% of young women LWPaHIV [ 119 ], with condom use reported in 20–30% [ 119 , 120 , 121 ]. In a recent UK study of women with LWPaHIV, 34% reported a previous pregnancy; 40% resulted in termination and 19% in miscarriage [ 119 ], with rates of termination being higher in this cohort of people LWPaHIV when compared to a US cohort of all women with HIV [ 122 ]. Alongside appropriate sexual health and contraceptive counselling, long-acting reversible contraception may be a pragmatic approach to the prevention of unintended pregnancy in this cohort with complex SRH needs.…”

“…Highly effective strategies to prevent cervical cancer include both hrHPV vaccination and cervical screening [ 125 ]. However, the implementation of these preventive measures varies globally; despite access, low cervical screening uptake has been demonstrated in young women LWPaHIV [ 119 ]. This may be due to embarrassment and fear of physician-led screening, as well as cultural barriers [ 119 ].…”

“…However, the implementation of these preventive measures varies globally; despite access, low cervical screening uptake has been demonstrated in young women LWPaHIV [ 119 ]. This may be due to embarrassment and fear of physician-led screening, as well as cultural barriers [ 119 ]. In a recent UK observational study of the HPV prevalence and serostatus in women LWPaHIV with a median age of 18 years (18–34), 14/46 (30%) individuals had hrHPV subtypes detected in cervical sampling, of which 2/14 (14%) were positive for HPV16 and 0/14 for HPV18 [ 126 ].…”

“…However, data gaps for men include parenting desires, fertility, incidence, and outcomes for partners and offspring [ 45 , 130 ]. Several studies in Europe and the US have suggested lower rates of pregnancy in people LWPaHIV than their HIV-negative peers, although rates of unplanned pregnancy and termination remain high in some cohorts [ 119 , 129 , 131 , 132 ]. Despite universal ART, women living with HIV remain at an increased risk of adverse maternal and perinatal outcomes when compared to pregnant people without HIV, including preterm delivery, low birth weight and small for gestation-age infants [ 133 , 134 ].…”