Fertility desires and preferences for safer conception strategies among people receiving care for HIV at a publicly-funded clinic in Seattle, WA

ABSTRACT

Understanding fertility desires and preferences for HIV prevention among individuals living with HIV, including the potential use of pre-exposure prophylaxis (PrEP) by HIV uninfected partners, can inform the delivery of safer conception counseling to reduce the risk of HIV transmission during pregnancy attempts. Men and women, predominantly heterosexual, engaged in HIV care in Seattle, WA, self-administered a questionnaire and we abstracted antiretroviral therapy (ART) status and HIV viral levels from medical records. We summarized participants’ sexual behavior, fertility desires, and preferences for safer conception strategies and used log-binomial regression to identify demographic, sexual, and behavioral factors associated with perceived acceptability of PrEP for HIV uninfected partners during pregnancy attempts. 52% of the 150 participants were female and the mean age was 48 years (range 23–74). 94.7% of participants were using ART and 79.3% had HIV viral load < 40 copies/mL. 22.2% of men and 34.6% of women reported that a healthcare provider had initiated discussion about fertility desires. 28.7% of participants were reproductive-age and desired children. Among sexually active reproductive-age participants with fertility desires, 56.3% reported inconsistent condom use and 62.5% did not report using effective birth control. 74.4% of reproductive age participants with fertility desires perceived that PrEP would be acceptable to an HIV uninfected partner and there were no significant predictors of PrEP acceptability. Nearly one third of reproductive-aged individuals living with HIV expressed fertility desires, highlighting a need for safer conception counseling in this setting. PrEP and ART were favored safer conception strategies.

KEYWORDS:

• HIV
• safer conception
• PrEP
• ART
• pregnancy

Acknowledgments

We thank the participants for their time and contributions to this study, as well as the efforts of the study team who facilitated the interview process.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Kerry A. Thomson http://orcid.org/0000-0002-1958-200X

Additional information

Funding

This research was funded by the University of Washington/ Fred Hutch Center for AIDS Research (CFAR), and Foundation for the National Institutes of Health [grant number AI027757]. KT and REDCap were supported by the National Center for Advancing Translational Sciences [grant number TL1TR000422, UL1TR000423]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.