Skip to main content

Fertility Desires Among HIV-Infected Men and Women in Los Angeles County: Client Needs and Provider Perspectives

Abstract

Combination antiretroviral therapy for persons living with HIV/AIDS (PLHA) has extended life expectancy, and enabled PLHA to live productive lives that can include having children. Despite calls to address childbearing for PLHA there has been limited attention to developing safe conception programs. This research sought to assess the childbearing desires of PLHA and the experiences of health care providers serving this population. Research entailed a brief cross-sectional client survey given to HIV-infected men and women over age 18 at two Los Angeles County clinics administered over an 8-week period. Focus group discussions were conducted with providers at each clinic site. Although 39 % of the 93 clients surveyed reported a desire to have children, two-thirds of clients had not discussed their desires, or methods of safe conception, with providers. Providers reported challenges in providing safe conception services in resource poor settings where clients cannot afford assisted fertility services and in the absence of national, state, or county guidelines for safe conception. They noted complex and varied client circumstances and a critical need for provider training in safe conception. Guidelines that focus on safe conception and harm reduction strategies as well as the legal ramifications of counseling on these practices are needed. HIV providers need training and patients need educational tools and workshops informing them of the risks, challenges, and options available to them and their partners to safely conceive and bear an HIV-negative child.

This is a preview of subscription content, access via your institution.

References

  1. Whitmore, S. K., Zhang, X., Taylor, A. W., & Blair, J. M. (2011). Estimated Number of Infants Born to HIV-infected women in the United States and five dependent areas, 2006. Journal of Acquired Immune Deficiency Syndromes, 57(3), 218–222.

    PubMed  Article  Google Scholar 

  2. Squires, K. E., Hodder, S. L., Feinberg, J., et al. (2011). Health needs of HIV-infected women in the United States: Insights from the women living positive survey. AIDS Patient Care STDS, 25(5), 279–285.

    PubMed  Article  Google Scholar 

  3. Burr, C. K., Fry, R. S., Weber, S., Armas-Kolostroubis, L. N., & Lampe, M. A. (2009). Integrating reproductive health into HIV care of women in the United States: It is time. AIDS, 23(14), 1928–1930.

    PubMed  Article  Google Scholar 

  4. Finocchario-Kessler, S., Sweat, M. D., Dariotis, J. K., et al. (2010). Understanding high fertility desires and intentions among a sample of urban women living with HIV in the United States. AIDS and Behavior, 14(5), 1106–1114.

    PubMed  Article  Google Scholar 

  5. Chen, J. L., Philips, K. A., Kanouse, D. E., Collins, R. L., & Miu, A. (2001). Fertility desires and intentions of HIV-positive men and women. Family Planning Perspectives, 33(4), 144–152, 165.

    PubMed  Article  CAS  Google Scholar 

  6. Gosselin, J. T., & Sauer, M. V. (2011). Life after HIV: Examination of HIV serodiscordant couples’ desire to conceive through assisted reproduction. AIDS and Behavior, 15(2), 469–478.

    PubMed  Article  Google Scholar 

  7. Sauer, M. V. (2006). American physicians remain slow to embrace the reproductive needs of human immunodeficiency virus-infected patients. Fertility and Sterility, 85(2), 295–297; discussion 301.

    PubMed  Article  Google Scholar 

  8. Newmeyer, T., Tecimer, S., Jaworksy, D., Chihrin, S., Gough, K., Rachlis, A., et al. (2011). Case series of fertility treatment in HIV-discordant couples (male positive, female negative): The Ontario experience. PLoS One, 6(9), 1–8. Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0024853.

  9. Matthews, L. T., & Mukherjee, J. S. (2009). Strategies for harm reduction among HIV-affected couples who want to conceive. AIDS and Behavior, 13(Suppl 1), 5–11.

    PubMed  Article  Google Scholar 

  10. Bekker, L. G., Black, V., Myer, L., Rees, H., Cooper, D., Mall, S., et al. (2011). Guideline on safer conception in fertile HIV-infected individuals and couples. The Southern African Journal of HIV Medicine, 12(2), 35–44.

    Google Scholar 

  11. NIAID. (2011). Treating HIV-infected people with antiretrovirals protects partners from infection: Findings result from NIH-funded international study. May 12, 2011. Available at: http://www.niaid.nih.gov/news/newsreleases/2011/Pages/HPTN052.aspx.

  12. Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., Vargas, L., et al. (2010). Preexposure chemoprophylaxis for HI prevention in men who have sex with men. New England Journal of Medicine, 363(27), 2587–2599.

    PubMed  Article  CAS  Google Scholar 

  13. Family Health International. Fem-PrEP project: FHI to initiate orderly closure of Fem-PrEP. FHI.org. April 18, 2011. Available at http://www.fhi.org/en/Research/Projects/FEM-PrEP.htm. CROI abstract at: http://www.retroconference.org/2012b/Abstracts/45406.htm.

  14. AVAC. AVAC says results of new PrEP trials provide clear evidence that antiretroviral drugs for prevention can help end the AIDS epidemic; calls for quick action o move landmark HIV prevention results toward lifesaving programs. In Paper presented at: International AIDS society conference on HIV pathogenesis, treatment and prevention 2011, Rome, Italy. Available at http://appliedclinicaltrialsonline.findpharma.com/appliedclinicaltrials/Phase+News/AVAC-Says-Results-of-New-PrEP-Trials-Provide-Clear/ArticleNewsFeed/Article/detail/731081?ref=25. Accessed July 20, 2011.

  15. See for example, http://Aidsinfo.nih.gov.

Download references

Acknowledgments

We would like to thank clinic leadership as well as the staff at the Valley Community Clinic (VCC) and the To Help Everyone (THE) Clinic for their support and assistance with the study. We also gratefully acknowledge the patients who participated in the study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Deborah Mindry.

Appendix: Survey on Fertility Desires and Reproductive Health Services

Appendix: Survey on Fertility Desires and Reproductive Health Services

Thank you for completing the survey. If you have had a child since testing HIV+, or if you are currently trying to have a child or have desires to have a child, and you would be willing to participate in a focus group with others HIV clients like yourself, please inform the clinic staff member who gave you this survey or your provider of your interest. Please note that your participation in this focus group is completely voluntary.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Mindry, D., Wagner, G., Lake, J. et al. Fertility Desires Among HIV-Infected Men and Women in Los Angeles County: Client Needs and Provider Perspectives. Matern Child Health J 17, 593–600 (2013). https://doi.org/10.1007/s10995-012-1035-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-012-1035-6

Keywords

  • Safe conception
  • HIV
  • United States
  • Fertility intentions
  • PLHA