Achieving pregnancy safely: perspectives on timed vaginal insemination among HIV-serodiscordant couples and health-care providers in Kisumu, Kenya

Abstract

In female-positive HIV-serodiscordant couples desiring children, home timed vaginal insemination (TVI) of semen during the fertile period along with consistent condom use may reduce the risk of HIV transmission when the man is HIV-uninfected. In sub-Saharan Africa, up to 45% of HIV-infected women desire to have more children. HIV viral load assessment is not routinely available in low-resource countries for monitoring adherence and response to antiretroviral therapy. Therefore, in these settings, timed unprotected intercourse without assurance of HIV viral suppression may pose unnecessary risks. TVI, a simple and affordable intervention, can be considered an adjunct method and option of safer conception for HIV prevention with treatment of the HIV-infected partner and/or pre-exposure prophylaxis. We conducted five mixed and single-sex focus group discussions comprised of 33 HIV-serodiscordant couples and health-care providers in the Nyanza region of Kenya to assess the acceptability and feasibility of TVI as a safer method of conception. The transcribed data were analyzed using a grounded theory approach. We found that educating and counseling HIV-serodiscordant couples on TVI could make it an acceptable and feasible safer conception method when associated with frequent communication and home visits by health-care providers. The findings of this study indicate that implementation studies that integrate training and counseling of HIV-serodiscordant couples and health-care providers on TVI combined with consistent condom use are needed. Acknowledging and supporting the reproductive choice and needs of female positive, male negative HIV-serodiscordant couples who desire children should also include the use of assisted reproductive services at the same time as pharmaceutical options that prevent sexual HIV transmission.

Trial registration: ClinicalTrials.gov identifier: NCT01468753.

Keywords:

• HIV-serodiscordant couples
• pregnancy
• safer conception
• vaginal insemination
• assisted reproduction
• condom use

Acknowledgments

We wish to thank the health-care providers, HIV-serodiscordant couples, and FACES staff for their valuable insight. At the time of the study, Drs O.M. and M.W. were at the University of California, San Francisco. The content is solely the responsibility of the authors and does not represent the official views or opinions of the Kenya Medical Research Institute and the Centre for Microbiology Research, NIAID, NIH, or the World Health Organization.

Funding

Dr O.M. was supported by a National Institute of Health (NIH) training grant [grant number T32AI065388] from the National Institute of Allergy and Infectious Diseases (NIAID). The research was supported by a grant from the NIH and the University of California – Gladstone Institute of Virology and Immunology Center for AIDS Research [grant number P30 AI027763].

Additional information

Funding

Funding: Dr O.M. was supported by a National Institute of Health (NIH) training grant [grant number T32AI065388] from the National Institute of Allergy and Infectious Diseases (NIAID). The research was supported by a grant from the NIH and the University of California – Gladstone Institute of Virology and Immunology Center for AIDS Research [grant number P30 AI027763].