A review of reproductive health research, guidelines and related gaps for women living with HIV

Abstract

The study of pregnancy and motherhood in women living with HIV (WLWH) has concentrated on the health of the unborn baby and the prevention of mother-to-child transmission, whereas consideration of the broader aspects of women's reproductive health has been largely overlooked. The rights of WLWH with respect to their reproductive health should be exactly the same as non-HIV-positive women, however, inequalities exist due to discrimination and also because the treatment guidelines used in the care of women are often based on insufficient evidence. The purpose of this article is to review the available literature on reproductive health issues for WLWH and to identify gaps requiring further investigation. Our review indicates that further research is warranted into a number of aspects of reproductive health among WLWH. Currently, access to the relevant reproductive health resources and services, such as advice on contraception and fertility services, for WLWH is far from optimal in many developed countries and most developing countries. More data are needed on the most appropriate family planning options with the consideration of drug interactions between contraceptives and antiretroviral therapy and the risk of HIV transmission. Also, more research is needed to improve understanding of the maternal health challenges facing WLWH. Similarly, our understanding of the impact of HIV on the physical and emotional health of pregnant women and new mothers is far from complete. Answering these questions and countering these inequalities will help to ensure the reproductive health and child-bearing intentions of WLWH become an integral part of HIV medicine.

Keywords:

• reproduction
• women
• HIV
• pregnancy
• conception

Acknowledgements

Women for Positive Action is a global initiative established in response to the need to address specific concerns of women living and working with HIV. Women for Positive Action is made up of healthcare professionals, WLWH and community group representatives from Canada, Europe and Latin America. Working together, the Women for Positive Action group aims to empower, educate, and support WLWH and the healthcare professionals and community advocates/leaders involved in their treatment; to explore the issues facing WLWH and provide meaningful, educational-based support to respond to these needs; and to contribute towards an enhanced quality of life for WLWH. For further information on this initiative please visit www.womenforpositiveaction.org. Women for Positive Action (WFPA) faculty who contributed to this article: Larissa Afonina (Russia), Adriana Ammassari (Italy), Jane Anderson (UK), Teresa Branco (Portugal), Elisabeth Crafer (UK), Antonella d'Arminio Monforte (Italy), Annette Haberl (Germany), Margaret Johnson (UK), Karine Lacombe (France), Anne-Mette Lebech (Denmark), Mona Loutfy (Canada), Mariana Mărdărescu (Romania), Fiona Mulcahy (Ireland), Angelina Namiba (UK), Ophelia Haanyama Ørum (Sweden), Maria Jesús Pérez Elías (Spain), Annette Piecha (Germany), Lorraine Sherr (UK), Ulrike Sonnenberg-Schwan (Germany), Winnie Ssanyu-Sseruma (UK) and Sharon Walmsley (Canada). We also acknowledge Litmus MME who provided medical writing support to the Women for Positive Action faculty. Women for Positive Action is an educational program funded and initiated by Abbott Laboratories.