Realizing Women Living with HIV’s Reproductive Rights in the Era of ART: The Negative Impact of Non-consensual HIV Disclosure on Pregnancy Decisions Amongst Women Living with HIV in a Canadian Setting
To better understand the structural drivers of women living with HIV’s (WLWH’s) reproductive rights and choices, this study examined the structural correlates, including non-consensual HIV disclosure, on WLWH’s pregnancy decisions and describes access to preconception care. Analyses drew on data (2014-present) from SHAWNA, a longitudinal community-based cohort with WLWH across Metro-Vancouver, Canada. Multivariable logistic regression was used to model the effect of non-consensual HIV disclosure on WLWH’s pregnancy decisions. Of the 218 WLWH included in our analysis, 24.8% had ever felt discouraged from becoming pregnant and 11.5% reported accessing preconception counseling. In multivariable analyses, non-consensual HIV disclosure was positively associated with feeling discouraged from wanting to become pregnant (AOR 3.76; 95% CI 1.82–7.80). Non-consensual HIV disclosure adversely affects WLWH’s pregnancy decisions. Supporting the reproductive rights of WLWH will require further training among general practitioners on the reproductive health of WLWH and improved access to women-centred, trauma-informed care, including non-judgmental preconception counseling.
KeywordsHIV Pregnancy Stigma Reproductive health Preconception counseling
We thank all those who contributed their time and expertise to this project, particularly participants, community partners, the SHAWNA Positive Women’s Advisory Board and Community Advisory Board, and the SHAWNA Project team: Sarah Moreheart, Brittany Udall, Jennifer Morris, Flo Ranville, Heidi Safford, Lauren Martin, Ray Croy, Bridgette Simpson, Anita Dhanoa, Monique Desroches, Lydia Hamel, Lulu Gurney, and Patience Chamboko. We also acknowledge Melissa Braschel, Abby Rolston, Sylvia Machat, Peter Vann, Erin Seatter, and Patricia McDonald for their research and administrative support. KS is supported by a Canada Research Chair in Global Sexual Health and HIV/AIDS and Michael Smith Foundation for Health Research. KS is supported by a Canada Research Chair in Global Sexual Health and HIV/AIDS and Michael Smith Foundation for Health Research. PD is supported by the Canadian Institutes for Health Research and Michael Smith Foundations for Health Research Postdoctoral Fellowship Award. JM received research support, paid to the institution, from the Public Health Agency of Canada, the BC-Ministry of Health, the US NIH (NIDA R01DA036307 and CTN 248), the Canadian Institutes of Health Research, Janssen & Janssen, and Merk.
Compliance with Ethical Standards
Conflict of interest
The authors have no conflicts of interest to declare.
Research Involving Human Participants
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study holds ethical approval through Providence Health Care/University of British Columbia Research Ethics Board and BC Women’s Hospital.
Informed consent was obtained from all individual participants included in the study.
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