Abstract
BackgroundWith the advent of effective treatment, women living with HIV can plan for pregnancy while minimizing risk of transmission to infants and seronegative partners. Family planning (FP) services tend to focus solely on addressing contraceptive need, but HIV-positive women—including female sex workers—often plan to have children someday. Various “safer conception” strategies are now available to support women living with HIV achieve fertility intentions, and integrated HIV/FP services may be a promising platform to offer these services.MethodsAt integrated community-based HIV/FP service delivery sites operated by Jhpiego’s Sauti project in Dar es Salaam, we conducted exit interviews with 300 HIV-positive female sex workers. Descriptive analyses were conducted to describe their desire for children, use of condoms and other modern contraceptive methods, self-reported viral suppression, and knowledge of and interest in safer conception strategies. We conducted bivariate and multivariate logistic regression analysis to examine correlates of fertility desire among respondents.ResultsMedian age of participants was 32. Nearly one-third wished to have a child within two years. Seventy-two percent had heard of having the HIV-positive partner taking ART to reduce sexual transmission during pregnancy attempts. Thirty-one percent felt the amount of FP content covered in the consultation was “too little.” Factors significantly associated with desire for children were having a nonpaying partner (adjusted odds ratio [AOR] 2.18, 95% confidence interval [CI]1.13–4.20) and having fewer children (AOR 0.65, 95% CI 0.48–0.87). Viral suppression was not associated with fertility desire.ConclusionsSex workers living with HIV attending integrated HIV/FP services have need for both contraception as well as safer conception counseling. This integrated service delivery modality is a promising platform for providing safer conception services. FP counseling for HIV-positive women should be broadened to broach the topic of safer pregnancy, as well as explicit counseling on strategies to minimize risk of sexual transmission to partners.
Highlights
Background/RationaleThe advent of effective antiretroviral treatment (ART) has ushered in an era in which women living with HIV can lead full and healthy lives, including having children if they so desire [1,2,3]
Factors significantly associated with desire for children were having a nonpaying partner and having fewer children (AOR 0.65, 95% CI 0.48–0.87)
Sex workers living with HIV attending integrated HIV/Family planning (FP) services have need for both contraception as well as safer conception counseling
Summary
The advent of effective antiretroviral treatment (ART) has ushered in an era in which women living with HIV can lead full and healthy lives, including having children if they so desire [1,2,3]. 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]. With the advent of effective treatment, women living with HIV can plan for pregnancy while minimizing risk of transmission to infants and seronegative partners. Various “safer conception” strategies are available to support women living with HIV achieve fertility intentions, and integrated HIV/FP services may be a promising platform to offer these services
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