title: Low Receipt and Uptake of Safer Conception Messages in Routine HIV Care: Findings From a Prospective Cohort of Women Living With HIV in South Africa.
abstract: BACKGROUND
  Safer conception strategies may be used by people living with HIV to reduce HIV transmission to partners resulting from condomless sex for conception. The extent to which people living with HIV receive safer conception messages and use risk reduction strategies is largely unknown.
  
  
  METHODS
  We use prospective data from a clinic-based cohort study in Johannesburg, South Africa. Women living with HIV (WLWH) aged 18-35 on antiretroviral therapy (n = 831) completed a baseline survey and ≥1 follow-up visits assessing fertility intentions and pregnancy incidence; an endline survey was administered 1 year postenrollment. Multivariate negative binomial regression models examined differences in the number of condomless sex acts by fertility intentions. Chi-squared statistics compared receipt of safer conception messages by fertility intentions and indicators of safer conception method use by partner HIV status.
  
  
  RESULTS
  The median baseline age of participants was 30.4 years and 25.3% were in serodiscordant partnerships. WLWH trying to conceive were over 3 times more likely to have condomless sex compared with those not trying to conceive (adjusted incidence rate ratio: 3.17, 95% confidence interval: 1.95 to 5.16). Receipt of specific safer conception messages was low, although women with positive fertility intentions were more likely to have received any fertility-related advice compared with those with unplanned pregnancies (76.3% vs. 49.1%, P < 0.001). Among WLWH trying to conceive (n = 111), use of timed unprotected intercourse was infrequent (17.1%) and lower in serodiscordant vs. concordant partnerships (8.5% vs. 26.9%, P = 0.010).
  
  
  CONCLUSIONS
  These findings suggest that clinic and patient-level interventions are needed to ensure that WLWH receive and use safer conception strategies.
authors: *Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA; †Wits Reproductive Health and HIV Institute (WRHI), University of the Witswatersrand, Johannesburg, South Africa; and ‡Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors: Riley J
authors: RJ
authors: Steiner
authors: Vivian
authors: V
authors: Black
authors: Helen
authors: H
authors: Rees
authors: Sheree R
authors: SR
authors: Schwartz
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D005306:Fertilization; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies; D040242:Risk Reduction Behavior; D021841:Safe Sex / Q000706:statistics & numerical data*; D012736:Sex Education / Q000379:methods*; D012725:Sexual Behavior; D012747:Sexual Partners; D013019:South Africa; D011795:Surveys and Questionnaires; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents