Addressing HIV positive women and men's reproductive health policy and health care needs

Background:Tailoring reproductive health policy and services for HIV positive women and men is pressing in countries where a sizeable reproductive age population is HIV positive. Accelerated roll-out of prevention of parent to child transmission and ARV treatment programs in developing countries heightens this need. Methods:In a survey conducted in 2006, interviews investigating reproductive intentions and associated policy and care needs were conducted with 285 women and 140 men attending HIV care and ARV treatment in Cape Town, South Africa. Data were analyzed using the stata statistical software program. Results:No specific policy addressed the reproductive intentions of HIV positive individuals. A sizeable proportion of HIV positive individuals considered having children. Across all ages, men had greater reproductive intentions than women. Women had increased reproductive intentions until their mid-20's. Among women and men <30 yrs, being on ARV treatment was significantly associated with greater fertility intentions (p<0.001). Nineteen percent of women were pregnant since testing HIV positive, with 61% unplanned; 28% of women reported inability to access contraception during their HIV care visit. Only 26% of women and 12% men had discussed reproductive intentions and needs with HIV care providers. Conclusions: Inadequate policy formulation and integration of reproductive health care and HIV care and treatment were identified. These results will inform policy and an NlH-funded collaborative study with Columbia University to develop, test and evaluate interventions to improve and link HIV and SRH service provision for HIV positive individuals in an advanced HIV/AIDS epidemic, developing country context.