Academic journal article Bulletin of the World Health Organization

Reproductive Choices for Women with HIV/Options a la Disposition Des Femmes Vivant Avec le VIH Dans le Domaine De la reproduction/Opciones Reproductivas Para Las Mujeres Con VIH

Academic journal article Bulletin of the World Health Organization

Reproductive Choices for Women with HIV/Options a la Disposition Des Femmes Vivant Avec le VIH Dans le Domaine De la reproduction/Opciones Reproductivas Para Las Mujeres Con VIH

Article excerpt

Introduction

Effective linkages between the sexual and reproductive health and the HIV fields are essential to ensuring the reproductive rights of people living with HIV. All women, including those with HIV, have the right "to d--de freely and responsibly on the number and spacing of their children and to have access to the information, education and means to enable them to exercise these rights". (1) The sexual and reproductive decisions faced by women with HIV involve their desire for pregnancy, their contraceptive practices, their choices about an unintended pregnancy, and their prenatal and postnatal options to reduce perinatal transmission of HIV (Fig. 1). (2)

For women with HIV, linkages between the sexual and reproductive health and HIV fields can maximize the opportunities to address four distinct reproductive possibilities: (2) (i) if a woman does not wish to become pregnant, she should be referred to or offered family planning services; (ii) if she wishes to become pregnant, she should be educated about the local infertility and prenatal services, the types of chemoprophylaxis available to reduce the risks of transmission to her child and, if in a sero-discordant relationship, HIV prevention approaches to minimize the risk of infection transmission to a partner when trying to conceive; (iii) if she is currently pregnant and wishes to continue her pregnancy, she should be offered the opportunity to obtain antiretroviral therapy to reduce HIV transmission risks; and (iv) if she is currently pregnant but does not wish to continue her pregnancy, she should be referred to safe abortion services. Postpartum contraception could be offered as an option for those who do not wish to become pregnant again.

Regardless of HIV status, increasing access to sexual and reproductive health services will not only offer women more control over their reproductive lives and help them safely achieve their desired fertility, but also will produce major public health benefits on maternal and infant morbidity and mortality. Voluntary contraceptive services, in particular, will benefit the health of women and infants in a variety of ways by delaying first births, lengthening birth intervals, reducing the total number of children born to one woman, preventing high-risk and unintended pregnancies, and reducing the need for unsafe abortion.

For those who are living with HIV, linking the sexual and reproductive health and HIV fields further enhances the public health impact by preventing pregnancies in women with HIV who do not wish to become pregnant, q-his in turn can reduce the number of infants born with HIV and the number of children orphaned due to AIDS. Indeed, prevention of unintended pregnancies in HIV-positive women is one of the four strategic elements recommended by WHO and its United Nations partners for PMTCT (Fig. 2).

Preventing unintended pregnancies

Four different analyses have confirmed the importance to PMTCT efforts of preventing unintended pregnancies in women with HIV. One study showed that moderate decreases in the number of pregnancies to HIV-infected women, ranging from 6% to 35% depending on the country, could result in numbers of averted HIV-positive births equivalent to those averted by antiretrovirals. (3) Another study demonstrated that adding family planning to PMTCT services in high-HIV prevalence countries could avert 71 000 child HIV infections compared with the 39 000 HIV-positive births averted with PMTCT only. (4) A third analysis suggested that current levels of contraceptive use in sub-Saharan Africa may already be preventing 22% (or 173 000) of HIV-positive births annually, despite contraception not being widely available in Sub-Saharan Africa. (5) If all women in the region who did not wish to get pregnant accessed contraceptive services, as many as an additional 160 000 HIV-positive births could be averted every year. Finally, a similar analysis done for the focus countries of the President's Emergency Plan for AIDS Relief (PEPFAR) found that the annual number of unintended HIV-positive births currently prevented through contraceptive use ranges from 178 in Guyana to 120 256 in South Africa. …

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