Strategies for Harm Reduction Among HIV-Affected Couples Who Want to Conceive

Abstract

As effective HIV treatments become more widespread, HIV-infected individuals are living longer, healthier lives. Many HIV-affected couples (sero-discordant and sero-concordant) are considering options for safer reproduction. A large body of evidence suggests that reproductive technologies can help HIV-affected couples to safely conceive with minimal risk of HIV transmission to their partner. However, for most couples such technologies are neither geographically nor economically accessible. This paper addresses the options for safer procreation among HIV-affected couples who cannot access reproductive technologies.

How the global call for elimination of pediatric HIV can support HIV-positive women to achieve their pregnancy intentions

“…68 One such example is the use of artificial insemination, which allows for conception while not introducing the risk of horizontal HIV transmission from an HIV-positive woman to her HIV-negative male partner during unprotected intercourse. 69 Though shown to be effective in research and clinical settings in regions such as western Europe, these methods are not available in many of the settings with the highest burden of HIV worldwide; where they are available, cost and other limitations place them out of reach for many HIV-affected couples.…”

“…70 Initiating an HIV-positive woman (or man) on ARVs, even if treatment is not indicated for disease management, can further suppress viral load, thus making transmission to the HIV-negative partner less likely. 68 Providing an HIV-negative partner with ARVs as pre-exposure prophylaxis has also been explored as a potentially effective strategy for preventing acquisition of HIV when attempting to conceive. 71 However, both of these interventions can be challenging in resourceconstrained settings where ARVs may not be widely available or where clinical guidelines restrict treatment to only HIV-positive individuals who are medically eligible for treatment.…”

The characteristics of HIV serodiscordant couples consulted at the HIV Out-Patient Clinic in Warsaw

“…Longer survival, approaching to that seen in the general population, and improved quality of life lead to more HIV positive persons willing to be involved in stable relationships and having a longterm family plan [6][7][8][9]. Furthermore, effective treatment reduces significantly the risk of HIV transmission, which is another way to protect HIV negative persons from infection [10][11][12][13][14].…”

A Social Ecological Approach to Exploring Barriers to Accessing Sexual and Reproductive Health Services among Couples Living with HIV in Southern Malawi

“…With a broader spectrum of reproductive options available to PLWH, evidence emerging from research conducted in developing countries indicates that ART may encourage PLWH receiving treatment to reconsider their reproductive decisions such as getting married and having children [2,4,5,9]. The use of ART is also associated with increased sexual activity in PLWH, as such increasing the likelihood of 2 ISRN Public Health pregnancies [10].…”

“…Studies from Africa suggest that HIV might modify, but not eliminate, broader desires to have children [2,13,14] and ART use may be associated with increased fertility desire among PLWH possibly through increased hopes for the future. These decisions are related to the "Lazarus effect" [15] where PLWH perceive that ARV allows them to live longer, and, have more "normal" social sexual lives, and possibly have healthy, HIV-negative children [4,9]. Consequently, worldwide there has been a shift in research, whereby efforts are now integrating reproductive health in the care and management of PLWH [8,14].…”