title: Achieving pregnancy safely: perspectives on timed vaginal insemination among HIV-serodiscordant couples and health-care providers in Kisumu, Kenya.
abstract: In female-positive HIV-serodiscordant couples desiring children, home timed vaginal insemination (TVI) of semen during the fertile period along with consistent condom use may reduce the risk of HIV transmission when the man is HIV-uninfected. In sub-Saharan Africa, up to 45% of HIV-infected women desire to have more children. HIV viral load assessment is not routinely available in low-resource countries for monitoring adherence and response to antiretroviral therapy. Therefore, in these settings, timed unprotected intercourse without assurance of HIV viral suppression may pose unnecessary risks. TVI, a simple and affordable intervention, can be considered an adjunct method and option of safer conception for HIV prevention with treatment of the HIV-infected partner and/or pre-exposure prophylaxis. We conducted five mixed and single-sex focus group discussions comprised of 33 HIV-serodiscordant couples and health-care providers in the Nyanza region of Kenya to assess the acceptability and feasibility of TVI as a safer method of conception. The transcribed data were analyzed using a grounded theory approach. We found that educating and counseling HIV-serodiscordant couples on TVI could make it an acceptable and feasible safer conception method when associated with frequent communication and home visits by health-care providers. The findings of this study indicate that implementation studies that integrate training and counseling of HIV-serodiscordant couples and health-care providers on TVI combined with consistent condom use are needed. Acknowledging and supporting the reproductive choice and needs of female positive, male negative HIV-serodiscordant couples who desire children should also include the use of assisted reproductive services at the same time as pharmaceutical options that prevent sexual HIV transmission.
authors.affiliation: a Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , MI , USA.
authors.forename: Okeoma
authors.initials: O
authors.lastname: Mmeje
authors.forename: Sheryl
authors.initials: S
authors.lastname: van der Poel
authors.forename: Meklit
authors.initials: M
authors.lastname: Workneh
authors.forename: Betty
authors.initials: B
authors.lastname: Njoroge
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bukusi
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
mesh_terms: D017280:Condoms; D003376:Counseling; D005260:Female; D015658:HIV Infections; D006282:Health Personnel; D006801:Humans; D007315:Insemination, Artificial; D007630:Kenya; D008297:Male; D061214:Patient Safety; D011247:Pregnancy; D012309:Risk-Taking; D012725:Sexual Behavior; D013997:Time Factors; D014621:Vagina
keywords: HIV-serodiscordant couples; assisted reproduction; condom use; pregnancy; safer conception; vaginal insemination
references.citation: Lancet. 2008 Jun 28;371(9631):2183-91
references.pmid: 18586173
references.citation: Lancet Infect Dis. 2011 Apr;11(4):263-4
references.pmid: 21453868
references.citation: Matern Child Health J. 2012 Feb;16(2):510-8
references.pmid: 21359828
references.citation: HIV Med. 2011 May;12(5):316-21
references.pmid: 21205129
references.citation: BMC Womens Health. 2010 Apr 28;10:13
references.pmid: 20423528
references.citation: Curr HIV Res. 2007 Jul;5(4):416-29
references.pmid: 17627505
references.citation: AIDS. 2010 Aug 24;24(13):1975-82
references.pmid: 20679759
references.citation: Soc Sci Med. 2007 Jul;65(2):274-83
references.pmid: 17451852