In May 2017, AIDS and Behavior published a consensus statement on the provision of safer conception services for men and women living with and affected by HIV.
It is time to implement safer conception services. This consensus is supported by science, consumer demand, and global goals to eliminate perinatal HIV transmission. We recommend that providers offer available safer conception services to HIV-affected men and women, and health program administrators integrate safer conception services into existing HIV and reproductive health programs. While the range of service choices may vary across settings, in all settings a minimal set of safer conception services is available. The most fundamental tenets of safer conception counseling are know your HIV-serostatus, know your partner’s HIV-serostatus, and wait until the partner living with HIV is on effective ART before attempting pregnancy. These basic tenets should be widely shared with HIV-affected persons, families, communities, and providers. We maintain that this work no longer needs to be the purview of specialists. Answers to outstanding questions will refine care, implementation, and policy but do not need to be resolved prior to offering services.
HIV-related stigma is a key barrier to uptake and delivery of safer conception care. People living with and affected by HIV who consider pregnancy or become pregnant and have children express internalized stigma and describe experiences of stigma from providers and community. Stigma compromises the willingness of clients to seek care and provider willingness to address reproductive goals with clients. It is imperative to acknowledge and support the sexual and reproductive rights of persons living with and affected by HIV and focus efforts on reducing stigma at individual-, provider-, and community-levels, such that HIV-affected men and women can make informed decisions and build healthy families.
We must develop tools that support HIV-affected persons to identify potential risk, engage with safer conception services, and use methods that align with preferences and level of risk. The goal is to engage all populations who could benefit from services including mutually-disclosed HIV-serodiscordant heterosexual couples, men and women living with or exposed to HIV, same sex couples, and seroconcordant-positive couples. Safer conception care must be flexible and address a diversity of clients.
We support development and implementation of strategies that can be adopted in diverse settings to support HIV-affected persons to achieve reproductive goals including increased access to ART and PrEP, HIV-RNA testing, STI testing, sperm washing and assisted reproductive technologies, and fertility care. Programs must be nimble in incorporating discussions about reproductive goals at many points in a client’s care without creating undue burden on providers or systems. Integrating safer conception messaging into public health targets for HIV prevention and treatment can maximize synergies.
Provider-initiated conversation is an important gateway to practicing safer conception. Providers across diverse disciplines and training-levels should be able to discuss reproductive options with HIV-affected couples and individuals. Tools to support providers to offer services are required, as are strategies and financing to support service integration .
Documenting the effect of safer conception is paramount for guidelines and for the confidence of providers and consumers. EMTCT and treatment as prevention initiatives dovetail with safer conception efforts. Data highlighting the advantages of these synergies may catalyze changes in policy and programs. Ensuring that the voices, values, preferences, and experiences of PLWH are at the forefront of safer conception messaging can normalize care-seeking and pregnancy in the context of HIV.
It is time to seize the opportunity to empower people affected by HIV to embrace their fertility goals and utilize safer conception strategies to satisfy goals for pregnancy with minimal HIV transmission risks. This group consensus is strongly supported by science, consumer demand, and global goals to reduce HIV incidence and eliminate perinatal transmission. We invite you to endorse this statement at https://www.hiveonline.org/saferconceptionendorse/