The role of family planning in achieving safe pregnancy for serodiscordant couples: commentary from the United States government's interagency task force on family planning and HIV service integration

Abstract

Introduction: People living with HIV (PLHIV) have the right to exercise voluntary choices about their health, including their reproductive health. This commentary discusses the integral role that family planning (FP) plays in helping PLHIV, including those in serodiscordant relationships, achieve conception safely. The United States (US) President’s Emergency Plan for AIDS Relief (PEPFAR) is committed to meeting the reproductive health needs of PLHIV by improving their access to voluntary FP counselling and services, including prevention of unintended pregnancy and counselling for safer conception. Discussion: Inclusion of preconception care and counselling (PCC) as part of routine HIV services is critical to preventing unintended pregnancies and perinatal infections among PLHIV. PLHIV not desiring a current pregnancy should be provided with information and counselling on all available FP methods and then either given the method onsite or through a facilitated referral process. PLHIV, who desire children should be offered risk reduction counselling, support for HIV status disclosure and partner testing, information on safer conception options to reduce the risk of HIV transmission to the partner and the importance of adhering to antiretroviral treatment during pregnancy and breastfeeding to reduce the risk of vertical transmission to the infant. Integration of PCC, HIV and FP services at the same location is recommended to improve access to these services for PLHIV. Other considerations to be addressed include the social and structural context, the health system capacity to offer these services, and stigma and discrimination of providers. Conclusion: Evaluation of innovative service delivery models for delivering PCC services is needed, including provision in community-based settings. The US Government will continue to partner with local organizations, Ministries of Health, the private sector, civil society, multilateral and bilateral donors, and other key stakeholders to strengthen both the policy and programme environment to ensure that all PLHIV and serodiscordant couples have access to FP services, including prevention of unintended pregnancy and safer conception counselling.

Safer conception for female sex workers living with HIV in Dar es Salaam, Tanzania: Cross-sectional analysis of needs and opportunities in integrated family planning/HIV services

“…In the past decade, worldwide, there has been a steady increase in research, service delivery, and advocacy to support women living with HIV to make informed decisions about whether, when, and how to become mothers [1,3,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. National normative guidelines on safer conception have been issued in Canada [26], South Africa [9], and the United Kingdom [27], and the World Health Organization delineates strategies for achieving safe and healthy pregnancy in its guidelines on the sexual and reproductive health and rights of women living with HIV [10].…”

Achieving 90-90-90: A Focus on Sero-Discordant Couples

“…Technologically advanced options for conception for sero-discordant couples include intrauterine or intravaginal insemination (of semen during the fertile period). Vaginal insemination is regarded as the safer method of conception to circumvent the sexual transmission of HIV [37]. However, it may not be accessible or affordable to all, especially in low to middle income countries [36,39].…”

“…ART literature shows that safe conception may be feasible when the infected partner is virally suppressed and on ART. While fully suppressive ART use may significantly reduce the chance of sexual transmission, sexual HIV transmission may still occur [36,37]. Limited and timed unprotected sex and -natural conception for HIV sero-discordant couples involves limited and timed unprotected sexual intercourse during the fertile periods.…”

“…Women are advised to track their menstrual and ovulation cycles. Couples are encouraged to minimise their sexual encounters to the fertile period to decrease the number of unprotected sexual encounters while maximising their chance of conception [35][36][37].…”

Managing Conception and Pregnancy for HIV Serodiscordant Couple: A Case Report

“…Preparing a serodiscordant couple for pregnancy requires proper planning. Education regarding risk of HIV transmission to the uninfected partner and the newborn is an important aspect (Mason et al 2017).…”