By the end of 2015 there were approximately 36.7 million people living with HIV globally, up to half of whom have HIV-negative partners. HIV-serodiscordant couples – that is, people living with HIV who have HIV-negative partners – who would like to have children, are often inadequately supported by or face significant barriers to accessing existing sexual and reproductive health services.
Fertility screening and HIV treatment and prevention – to minimise HIV infection, whilst working towards achieving pregnancy safely – are crucial for all serodiscordant couples, regardless of whether or not they have fertility problems.
Special Supplement
A special supplement, Achieving pregnancy safely by HIV-serodiscordant couples, has been published in The Journal of the International AIDS Society, which highlights the needs of couples affected by HIV who would like children, including the critical importance of integrating fertility screening and HIV treatment and prevention services.
International Women’s Day
Published on the occasion of International Women’s Day, the supplement shows that an integrated approach to sexual and reproductive healthcare provision, which places the human rights, needs and perspectives of women and partners at the centre, is more effective in supporting serodiscordant couples in achieving pregnancy safely.
The authors of the editorial comment: ‘rights-based, comprehensive and integrated strategies better support safe pregnancy outcomes for people in HIV-serodiscordant relationships than more traditionally “Siloed” reproductive health and HIV interventions.’
Barriers and progress
Co-authored and co-edited by staff at WHO Department of Reproductive Health and Research including the Human Reproduction Programme (HRP) the special supplement includes 9 articles. These provide a wide range of perspectives from healthcare providers
and HIV-serodiscordant couples, with a particular focus on sub-Saharan Africa. They describe obstacles and continuing challenges as well as progress made to integrating fertility care, into sexual and reproductive healthcare services for couples affected
by HIV.
WHO guidelines
The special supplement also highlights recommended options which can help women living with HIV achieve pregnancy safely, included in the recently published WHO Consolidated guideline on sexual and reproductive health and rights of women living with HIV. These include:
- antiretroviral therapy (ART) use by the person living with HIV to suppress viral load;
- use of oral pre-exposure prophylaxis (PrEP) by the partner who does not have HIV;
- sexual intercourse without condom use when the women is at peak fertility;
- screening and treatment of sexually transmitted infections in both partners;
- voluntary medical male circumcision for HIV-negative men to reduce their risk of HIV acquisition;
- and assisted semen insemination.