title: Fertility desires among HIV-infected men and women in Los Angeles County: client needs and provider perspectives.
abstract: Combination antiretroviral therapy for persons living with HIV/AIDS (PLHA) has extended life expectancy, and enabled PLHA to live productive lives that can include having children. Despite calls to address childbearing for PLHA there has been limited attention to developing safe conception programs. This research sought to assess the childbearing desires of PLHA and the experiences of health care providers serving this population. Research entailed a brief cross-sectional client survey given to HIV-infected men and women over age 18 at two Los Angeles County clinics administered over an 8-week period. Focus group discussions were conducted with providers at each clinic site. Although 39% of the 93 clients surveyed reported a desire to have children, two-thirds of clients had not discussed their desires, or methods of safe conception, with providers. Providers reported challenges in providing safe conception services in resource poor settings where clients cannot afford assisted fertility services and in the absence of national, state, or county guidelines for safe conception. They noted complex and varied client circumstances and a critical need for provider training in safe conception. Guidelines that focus on safe conception and harm reduction strategies as well as the legal ramifications of counseling on these practices are needed. HIV providers need training and patients need educational tools and workshops informing them of the risks, challenges, and options available to them and their partners to safely conceive and bear an HIV-negative child.
authors.affiliation: Center for Culture and Health, Department of Psychiatry and Behavioral Sciences, NPI-Semel Institute for Neuroscience, University of California, Los Angeles, CA 90024-1759, USA. dmindry@ucla.edu
authors.forename: Deborah
authors.initials: D
authors.lastname: Mindry
authors.forename: Glenn
authors.initials: G
authors.lastname: Wagner
authors.forename: Jordan
authors.initials: J
authors.lastname: Lake
authors.forename: Amber
authors.initials: A
authors.lastname: Smith
authors.forename: Sebastian
authors.initials: S
authors.lastname: Linnemayr
authors.forename: Molly
authors.initials: M
authors.lastname: Quinn
authors.forename: Risa
authors.initials: R
authors.lastname: Hoffman
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005193:Family Planning Services; D005260:Female; D005298:Fertility; D017144:Focus Groups; D015658:HIV Infections / Q000523:psychology*; D006301:Health Services Needs and Demand; D006801:Humans; D033182:Intention; D016015:Logistic Models; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D009042:Motivation; D057240:Patient Preference; D010549:Personal Satisfaction; D012098:Reproduction; D012747:Sexual Partners; D012959:Socioeconomic Factors; D055815:Young Adult