Consensus statement: Supporting Safer Conception and Pregnancy For Men And Women Living with and Affected by HIV

• Published in: AIDS and behavior 2018-06, Vol.22 (6), p.1713-1724
• Main Authors: Matthews, Lynn T., Beyeza-Kashesya, Jolly, Cooke, Ian, Davies, Natasha, Heffron, Renee, Kaida, Angela, Kinuthia, John, Mmeje, Okeoma, Semprini, Augusto E., Weber, Shannon
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Anti-Retroviral Agents - therapeutic use; Artificial insemination; Child; Circumcision, Male; Commentary; Couples; Family Characteristics; Female; Fertility; Fertilization; Health care; Health care policy; Health Psychology; Health services; Health Services Accessibility; Heterosexuality; HIV; HIV Infections - drug therapy; HIV Infections - prevention & control; Human immunodeficiency virus; Humans; Incidence; Infectious Diseases; Insemination, Artificial; Interest groups; Male; Medicine; Medicine & Public Health; Men; Mens health; Objectives; Pre-Exposure Prophylaxis; Preconception Care; Pregnancy; Public Health; Reproductive Behavior; Reproductive Health; Reproductive Health Services; Safe Sex; Semen; Sexual Partners; Sexually transmitted diseases; Social Stigma; STD; Training; Women; Womens health
• ISSN: 1090-7165; 1573-3254
• DOI: 10.1007/s10461-017-1777-7

Safer conception interventions reduce HIV incidence while supporting the reproductive goals of people living with or affected by HIV. We developed a consensus statement to address demand, summarize science, identify information gaps, outline research and policy priorities, and advocate for safer conception services. This statement emerged from a process incorporating consultation from meetings, literature, and key stakeholders. Three co-authors developed an outline which was discussed and modified with co-authors, working group members, and additional clinical, policy, and community experts in safer conception, HIV, and fertility. Co-authors and working group members developed and approved the final manuscript. Consensus across themes of demand, safer conception strategies, and implementation were identified. There is demand for safer conception services. Access is limited by stigma towards PLWH having children and limits to provider knowledge. Efficacy, effectiveness, safety, and acceptability data support a range of safer conception strategies including ART, PrEP, limiting condomless sex to peak fertility, home insemination, male circumcision, STI treatment, couples-based HIV testing, semen processing, and fertility care. Lack of guidelines and training limit implementation. Key outstanding questions within each theme are identified. Consumer demand, scientific data, and global goals to reduce HIV incidence support safer conception service implementation. We recommend that providers offer services to HIV-affected men and women, and program administrators integrate safer conception care into HIV and reproductive health programs. Answers to outstanding questions will refine services but should not hinder steps to empower people to adopt safer conception strategies to meet reproductive goals.