Pre-Conception
Gaps in Research
- 1.
- Women and their sexual partners need access to comprehensive pre-conception care so they can make informed decisions about pregnancy before conception.
- 2.
- Interventions are needed to support the autonomous decision-making of HIV-positive women who are caught between the contradictory pressures of family, community and health care providers.
- 3.
- Some HIV-positive men and women would consider adoption.
- 4.
- Additional research is needed on the use of pre-exposure prophylaxis to prevent HIV transmission for conception purposes.
- 5.
- High dose folates are needed for women of childbearing age on efavirenz.
- 6.
- Women and their sexual partners need to know and understand how seroconversion can occur during pregnancy.
1. Women and their sexual partners need access to comprehensive pre-conception care so they can make informed decisions about pregnancy before conception. Studies found that HIV-positive women could not access pre-conception advice on safer pregnancy options, as health providers discouraged pregnancy. Studies found that significant numbers of pregnant women did not know any way to prevent vertical transmission and face dilemmas with balancing the desire for children with fear of risking acquiring HIV or transmitting HIV to their partner or infant. Studies also showed that women did not understand the relationship between high CD4 counts and reducing the risk of HIV transmission.
Gap noted, for example, in South Africa (Matthews et al., 2011); Uganda (Beyeza-Kashesya et al., 2009); Kenya (Awiti Ujiji et al., 2010; Awiti Ujiji et al., 2011); Mozambique (Hayford and Agadjanian, 2010); Vietnam (Chi et al., 2010a); South Africa (London et al., 2008); China (Luo and He, 2008); globally (Hirsch, 2007; Delvaux and Nostlinger, 2007).
2. Interventions are needed to support the autonomous decision-making of HIV-positive women who are caught between the contradictory pressures of family, community and health care providers. Studies found that HIV-positive women and men need information and social support to make decisions that reflect their own preferences in the face of pressure to bear children. A review of the published literature from 1990 to 2008 found that the refusal of health workers to discuss reproductive options in a non-biased way negatively impacts HIV-positive women. Studies also found that HIV-positive men lacked information on pre-conception and felt they could not request this information from health providers.
Gap noted, for example, in Nigeria (Smith and Mbakwem, 2010); Uganda (Kisakye et al., 2010); Vietnam (Oosterhoff et al., 2008a; Oosterhoff et al., 2008b); Brazil (Paiva et al., 2003); and South Africa (Nduna and Farlane, 2009).
3. Some HIV-positive men and women would consider adoption. A study found that HIV-positive men and women would consider adopting a child as an alternative to having a biological child.
Gap noted, for example, in South Africa (Cooper et al., 2009).
4. Additional research is needed on the use of pre-exposure prophylaxis to prevent HIV transmission for conception purposes. Knowledge is needed on optimal dosing, teratogenicity, cost, adherence, resistance and risk compensation.
Gap noted globally (Matthews et al., 2010).
5. High dose folates are needed for women of childbearing age on efavirenz. Iron folate prevents neural defects, a potential risk of using efavirenz.
Gap noted, for example, in numerous developing countries (Ford et al., 2010a).