Vol.:(0123456789)
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AIDS and Behavior
https://doi.org/10.1007/s10461-018-2170-x
SUBSTANTIVE REVIEW
A Systematic Review of the Current Status of Safer Conception
Strategies for HIV Aected Heterosexual Couples in Sub‑Saharan
Africa
D. Joseph Davey
1,2
· S. West
3
· V. Umutoni
4
· S. Taleghani
1
· H. Klausner
5
· E. Farley
2
· R. Shah
4
· S. Madni
4
·
S. Orewa
4
· V. Kottamasu
4
· V. Rice
4
· Z. Robbin
4
· K. M. Wall
4
© Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract
We conducted a systematic review of safer conception strategies (SCS) for HIV-affected couples in sub-Saharan Africa to
inform evidence-based safer conception interventions. Following PRISMA guidelines, we searched fifteen electronic data-
bases using the following inclusion criteria: SCS research in HIV-affected couples; published after 2007; in sub-Saharan
Africa; primary research; peer-reviewed; and addressed a primary topic of interest (SCS availability, feasibility, and accept-
ability, and/or education and promotion). Researchers independently reviewed each study for eligibility using a standardized
tool. We categorize studies by their topic area. We identified 41 studies (26 qualitative and 15 quantitative) that met inclusion
criteria. Reviewed SCSs included: antiretroviral therapy (ART), pre-exposure prophylaxis, timed unprotected intercourse,
manual/self-insemination, sperm washing, and voluntary male medical circumcision (VMMC). SCS were largely unavailable
outside of research settings, except for general availability (i.e., not specifically for safer conception) of ART and VMMC.
SCS acceptability was impacted by low client and provider knowledge about safer conception services, stigma around HIV-
affected couples wanting children, and difficulty with HIV disclosure in HIV-affected couples. Couples expressed desire
to learn more about SCS; however, provider training, patient education, SCS promotions, and integration of reproductive
health and HIV services remain limited. Studies of provider training and couple-based education showed improvements in
communication around fertility intentions and SCS knowledge. SCS are not yet widely available to HIV-affected African cou-
ples. Successful implementation of SCS requires that providers receive training on effective SCS and provide couple-based
safer conception counseling to improve disclosure and communication around fertility intentions and reproductive health.
Keywords HIV · Safer conception · Africa · Fertility · Pregnant · Serodiscordant · Couples
Introduction
Since the introduction of antiretroviral therapy (ART), preg-
nancy rates and the desire to conceive have increased among
men and women living with HIV due to longer life expec-
tancy, improved quality of life, and dramatic reductions in
mother to child HIV transmission [1–4]. However, attempts
to conceive among HIV affected couples may increase sexual
transmission of HIV [2–4], and HIV acquisition during peri-
natal periods increases the risk of mother-to-child transmis-
sion [5, 6]. Further, pregnancy itself is a time of increased
HIV risk. Mechanisms of increased susceptibility of HIV
acquisition during pregnancy and breastfeeding may be due
to hormonal changes that alter genital mucosal surfaces or
distribution of target cells at these surfaces, and behavioral
factors such as condomless sex and multiple partners also
* D. Joseph Davey
dvoradavey@ucla.edu
1
Department of Epidemiology, Fielding School of Public
Health, University of California Los Angeles, 650 Charles E
Young Dr S, Los Angeles, CA 90095, USA
2
Division of Epidemiology and Biostatistics, School of Public
Health and Family Medicine, University of Cape Town,
Cape Town, South Africa
3
Department of Epidemiology, Mailman School of Public
Health, Columbia University, New York, NY, USA
4
Department of Epidemiology, Rollins School of Public
Health, Emory University, Atlanta, GA, USA
5
Cornell University, Ithaca, NY, USA
@Phil_Robichaud
@deepthiw
@JoseServera