Low Receipt and Uptake of Safer Conception Messages in Routine HIV Care: Findings from a Prospective Cohort of Women Living with HIV in South Africa

BACKGROUND:

Safer conception strategies may be used by people living with HIV (PLWH) to reduce HIV transmission to partners resulting from condomless sex for conception. The extent to which PLWH receive safer conception messages and use risk reduction strategies is largely unknown.

METHODS:

We use prospective data from a clinic-based cohort study in Johannesburg, South Africa. Women living with HIV (WLWH) aged 18-35 on antiretroviral therapy (n=831) completed a baseline survey and ≥1 follow-up visits assessing fertility intentions and pregnancy incidence; an endline survey was administered one year post-enrollment. Multivariate negative binomial regression models examined differences in the number of condomless sex acts by fertility intentions. Chi-squared statistics compared receipt of safer conception messages by fertility intentions, as well as indicators of safer conception method use by partner HIV status.

RESULTS:

The median baseline age of participants was 30.4 years and 25.3% were in serodiscordant partnerships. WLWH trying to conceive were over three times more likely to have condomless sex compared to those not trying to conceive (aIRR: 3.17, 95%CI: 1.95-5.16). Receipt of specific safer conception messages was low, although women with positive fertility intentions were more likely to have received any fertility-related advice compared to those with unplanned pregnancies (76.3% vs. 49.1%, p<0.001). Among WLWH trying to conceive (n=111), use of timed unprotected intercourse was infrequent (17.1%) and lower in serodiscordant versus concordant partnerships (8.5% vs 26.9%, p=0.010).

CONCLUSIONS:

These findings suggest that clinic and patient-level interventions are needed to ensure that WLWH receive and employ safer conception strategies.

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By:  Steiner RJ1, Black V, Rees H, Schwartz SR.

• 1 a Emory University Rollins School of Public Health, Department of Behavioral Sciences and Health Education 
• b Wits Reproductive Health and HIV Institute (WRHI), University of the Witswatersrand 
• c Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health.
• J Acquir Immune Defic Syndr. 2016 Feb 5. 

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