HIV Care Providers' Communication with Patients About Safer Conception for People Living with HIV in Tanzania.

CONTEXT: People living with HIV may desire children, but often lack information about safer conception and pregnancy and face barriers to obtaining high-quality reproductive health services. To inform clinical guidance that supports HIV-affected couples wanting to conceive, it is important to better understand communication between patients and providers about childbearing and safer-conception guidelines for people living with HIV. METHODS: In-depth interviews were conducted with 30 providers of HIV-related services in seven health facilities in Iringa, Tanzania, and with 60 HIV-positive women and men attending study facilities. The study followed an iterative research process and used thematic content analysis. RESULTS: Providers reported that they had received limited training on childbearing and safer conception for HIV-positive people, and that clinical guidance in Tanzania on the subject is poor. Although many providers mentioned that people living with HIV have the right to bear children, some HIV-positive patients reported having been discouraged by providers from having more children. Only a few HIV-positive patients reported having learned about safer-conception strategies for HIV-affected couples through discussions with health providers. CONCLUSIONS: Guidance on safer-conception and safe-pregnancy counseling for women and men living with HIV in Tanzania needs to be updated. It is critical that providers be trained in safe pregnancy and safer conception for HIV-affected couples, and that HIV and sexual and reproductive health services be integrated, so that HIV-positive patients and their partners are able to plan their pregnancies and to receive the care they need to manage their health and their pregnancies. International Perspectives on Sexual and Reproductive Health, 2016, 42(4): 179-186. The availability of antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV (PMTCT) services for people living with HIV has grown in Tanzania. (1) The country has made great strides toward reducing the rate of mother-to-child HIV transmission by adopting Option B+, the recommendation by the World Health Organization (WHO) that all HIV-positive pregnant and lactating women be counseled to initiate lifelong ART. (2) Advances in HIV treatment and PMTCT have been shown to increase fertility desires of people living with HIV (3-5) Indeed, many HIV-positive women and men in Tanzania express a strong desire to have children, (6) yet not only lack information regarding safe conception and childbearing, but also face barriers to obtaining high-quality reproductive health services. (7-9) Developments in safer-conception technologies have led to the creation of international and national guidelines on the childbearing needs of women and men living with HIV. These guidelines seek to protect the health of HIV-positive pregnant women and prevent transmission of the virus from mothers to children and within serodiscordant couples (or reinfection within seroconcordant couples). In 2006, WHO published sexual and reproductive health guidelines for women living with HIV in resource-constrained settings. (10) The guidelines recommend that special counseling and support be provided to HIV-positive women planning a pregnancy--regardless of whether their partner is infected--and offer several low-technology safer-conception strategies to reduce the risks of HIV infection or reinfection. For example, WHO suggests that HIV-seroconcordant couples limit unprotected sex--and thus exposure to the risk of reinfection--to the fertile times of the woman's menstrual cycle. The guidelines stop short of making official recommendations for safer-conception strategies for serodiscordant couples, but they do discuss various options. The effectiveness of safer-conception strategies for serodiscordant couples depends on whether the HIV-positive partner is the man or the woman. …