Approximately 40% of HIV-positive adults starting antiretroviral therapy (ART) in the United States would like to have children in the future, a proportion that remained unchanged after two years of follow-up, investigators report in Open Forum Infectious Diseases. There was no significant difference in the proportion of women, men who have sex with women (MSW) and men who have sex with men (MSM) who said they would like to have children. Younger people and black MSM were more likely to want to have children.
The investigators believe their findings show the importance of regular assessment of the reproductive health and conception needs of HIV-positive people.
“Our data showed that overall, MSM, MSW and W [women] have similar parenting desires,” comment the authors. “Hence, all of these populations would benefit from preconception counseling, counseling about methods of contraception, and understanding how to prevent transmitting HIV to uninfected partners or to their future children.”
The investigators undertook the study because little is currently known about the parenting desires of people living with HIV. The only studies to examine this were conducted 20 or more years ago and did not include MSM. Because of ART, many HIV-positive people have an excellent prognosis; moreover HIV is untransmittable by individuals with an undetectable viral load. In the US pregnancy and live birth rates among women with HIV are close to those observed in HIV-negative women.
Participants were recruited between 2009 and 2011 as part of a study of ART regimens for treatment-naïve individuals. Data were analysed from adult men (over the age of 18) and adult women of reproductive age (18-45 years).
At baseline and after 96 weeks of therapy, participants were asked if they would like to have children in the future (yes/unsure/no). Men were stratified according to whether they were MSM or were exclusively heterosexual.
A total of 1425 people were recruited. Most (70%) were MSM, 13% were women and 17% were heterosexual men. The median age was 36 years. Thirty-nine per cent of people were black and 36% were white. Two-thirds had some post-high school education and half were living on a low income (below $20,000 a year).
At baseline, 86% of MSM reported having no children, with only 27% of both heterosexual men and women reporting having no children.
Before starting ART, 41% of participants said they wanted or may want children in the future (yes/unsure). This included 42% of MSM, 37% of heterosexual men and 43% of women. The proportion saying they wanted or may want children in the future was unchanged after 96 weeks of follow-up, remaining at 41%. Although the proportions were near identical to baseline, approximately 10% of each group who initially desired children changed their minds, as did an equal proportion of people who at baseline said they did not desire children.
Factors associated with wanting children included being under the age of 30, a post-high school education and having no children. Among MSM, parenting desire was associated with younger age and black ethnicity. Women under the age of 30 and women had fewer than three children were more likely to desire children in the future.
Almost all participants (95%) had an undetectable viral load at week 96, but the investigators found no significant association between either viral suppression or CD4 cell count and parenting desire.
The authors believe their findings have several important implications for improving the care of people with HIV:
- Healthcare providers should assess the reproductive desires and contraception needs of all HIV-positive individuals.
- Information should be provided on safer conception practices with the highest likelihood of conception success.
- Tailored conception counselling should be available.
- Women wanting to conceive should be provided with information about obtaining and maintaining an undetectable viral load and behaviours – such as stopping smoking – that promote fertility.
- People who do not wish to conceive should be offered safe and appropriate contraception.
- Healthcare providers should be aware of community and medical resources for MSM who wish to have children, including adoption and surrogacy.
Cohn SE et al. Parenting desires among individuals living with HIV in the United States. Open Forum Infectious Diseases, ofy232, 2018. (Full text freely available.)