Barriers and Promoters to Uptake of Safer Conception Strategies among HIV-serodiscordant Couples with Fertility Intention in Mbarara, Uganda

Abstract

Background: We investigated barriers and promoters to uptake of a safer conception approach to pregnancy among HIV serodiscordant couples in Mbarara, southwestern Uganda. Methods: We recruited HIV-infected men and women (index) receiving antiretroviral therapy (ART) from the Uganda Antiretroviral Rural Treatment Outcomes cohort who reported an uninfected or unknown status partner (partner), serostatus disclosure to the partner, and personal or partner desire for a child within 2 years. We conducted 40 separate in-depth interviews with 20 couples to explore periconception risks and awareness of specific safer conception strategies. Data were translated, transcribed, and analyzed using content analysis. Results: 12/20 index participants were women, with median age of 36 yrs [IQR 29-41], and median recent CD4 of 433 cells/mm3 [IQR: 277-575]. Median partner age was 34yrs [IQR 30-40]. Awareness of HIV prevention strategies beyond condoms and abstinence was limited, however, some participants described timed intercourse and ‘ART as prevention’ as ways to reduce HIV transmission. Participants were motivated to learn more A61 AIDS Research and Human Retroviruses 2014.30: A61-A62. Downloaded from online.liebertpub.com by 46.246.28.95 on 12/09/15. For personal use only. about safer conception strategies. Key barriers included limited couple communication about childbearing plans and understanding of HIV sero-discordance. Fatalism about eventual HIV acquisition by the uninfected partner or a sense of protection due to ‘‘strong blood’’ or ‘‘God’s will’’ were common perceptions that decreased motivation to practice HIV prevention. Many participants prioritized pregnancy with minimal perceived options for reducing HIV risk. The more vulnerable partner (HIV infected and/or female) was often eager to pursue pregnancy to secure the relationship, regardless of HIV acquisition or transmission risks. Conclusions: Awareness of ART for prevention and high interest in other safer conception strategies presents opportunity to encourage mutual status disclosure, contravene normative expectations of eventual seroconversion, and promote strategies to minimize periconception HIV risks.