“We weren't using condoms because we were trying to conceive”: The need for reproductive counseling for HIV+ women in clinical care

Background: Although a significant number of HIV+ women intend to have children in the future, few have the opportunity to work with providers to safely plan pregnancy. Department of Health & Human Services recently published guidelines for HIV preconception counseling to assist providers. We assessed childbearing plans and provider communication with HIV+ women.

Methods: We conducted n=20 semi-structured in depth interviews with HIV+ adolescent and adult women receiving HIV clinical care in an urban setting. Participants were purposively sampled to include diversity in age and childbearing plans. Interview transcripts were analyzed and coded independently by two study team members before reaching consensus on emergent themes.

Results: Among this sample of HIV+ women (mean age =28.8, 95% African-American, 50% on ART, 70% want a child), many reported inconsistent condom use; regardless of their childbearing goals. Women actively trying to conceive recognized the risk to themselves and their partner, but had not talked with their provider. Several women reported some discussion of childbearing with their provider, but the majority reported inaccurate information regarding transmission risks. Data regarding provider dynamics were organized as follows: 1) confusion and concern on how to safely conceive, 2) comfort level discussing childbearing with a provider, and 3) provider guidance offered. Even in this unique setting where referrals for preconception counseling are possible, women were unaware of this specialized service.

Conclusion: Provider initiated reproductive counseling is needed to strategically avoid or plan pregnancy and reduce risk of transmission to partners and infants; versus leaving it to chance.