Fertility Desire and Associations with Condomless Sex, Antiretroviral Adherence, and Transmission Potential in a Cohort of Kenyan Women Living with HIV in Sero-discordant Relationships: A Mixed Methods Study

For women living with HIV (WLH) in serodiscordant partnerships, decisions about childbearing can challenge condom use and antiretroviral adherence. In a prospective cohort of 148 WLH in serodiscordant partnerships, 58 (39%) wanted more children in the future but were not currently trying to conceive...

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Bibliographic Details
Published in:AIDS and behavior 2023-08, Vol.27 (8), p.2803-2814
Main Authors: Eastment, McKenna C., Kinuthia, John, Tapia, Kenneth, Wanje, George, Wilson, Katherine, Kaggiah, Anne, Simoni, Jane M., Mandaliya, Kishorchandra, Poole, Danielle N., Richardson, Barbra A., Jaoko, Walter, John-Stewart, Grace, McClelland, R. Scott
Format: Article
Language:English
Subjects:
Anti-Retroviral Agents - therapeutic use
Antigens
Antiretroviral agents
Antiretroviral drugs
Antiretroviral therapy
Child
Childbirth & labor
Disease transmission
Family planning
Female
Fertility
Health behavior
Health Psychology
Health risks
HIV
HIV Infections - drug therapy
HIV Infections - epidemiology
HIV Infections - prevention & control
Human immunodeficiency virus
Humans
Infectious Diseases
Kenya - epidemiology
Male
Medicine
Medicine & Public Health
Mixed methods research
Original Paper
Partnerships
Patient compliance
Pregnancy
Prescription drugs
Prospective Studies
Prostate-Specific Antigen
Public Health
Secretions
Sex
Sexual behavior
Sexual Partners
Sexually transmitted diseases
STD
Unsafe Sex
Women
Womens health
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Summary:For women living with HIV (WLH) in serodiscordant partnerships, decisions about childbearing can challenge condom use and antiretroviral adherence. In a prospective cohort of 148 WLH in serodiscordant partnerships, 58 (39%) wanted more children in the future but were not currently trying to conceive (fertility desire), and 32 (22%) were currently trying to become pregnant (fertility intent). Detection of prostate specific antigen (PSA) in vaginal secretions, a marker for recent condomless sex, was lowest in women with fertility desire and highest in women with fertility intent. Detectable viral load followed a similar pattern. Risk of HIV transmission, when condomless sex and PSA detection occurred concurrently, was three to fourfold higher at visits with fertility intent compared to visits with fertility desire. Qualitative interviews underscored the importance women place on childbearing and suggested that they had limited information about the role of antiretroviral therapy in reducing sexual HIV transmission.
ISSN:1090-7165
1573-3254
DOI:10.1007/s10461-023-04004-4