Preconception Care for People Living with HIV

Throughout much of the HIV epidemic, people living with HIV were largely discouraged from having children because of the risk of mother-to-child transmission. Highly active antiretroviral therapy, which came about in the mid-1990s, was a game changer, reducing the risk of maternal transmission to as low as one or two percent. However, that hopeful news didn’t catch on among many patients and providers, says Riley Steiner, MPH, a Sommer Scholar and 2011 graduate of the Johns Hopkins Bloomberg School of Public Health who is working with Johns Hopkins-affiliated researchers on preconception care issues for people living with HIV.

“Historically, many providers assumed that HIV-positive women wouldn’t want to have a child,” says Steiner. “Even now, many people who are living with HIV don’t realize there are ways to make conception and childbearing safe.”

Findings that she and colleagues published in a supplement of AIDS were presented November 13 at the International Conference on Family Planning. Common assumptions about childbearing and HIV are off the mark, according to their research. Many HIV-positive individuals indeed are interested in having biological children, but healthcare providers often don’t initiate conversations about how to proceed in the safest way for all concerned: mother, partner and child.

The team provides a framework for improving conversations between healthcare providers and patients. Decisions that need to be made include which care providers would be equipped for handling different aspects of preconception care (including offering counseling, contraceptives, and antiretroviral therapy); when preconception planning should take place (at regular times throughout the year, or at milestone events such as having a new partner); and where preconception planning should take place (as part of a complete HIV care package, or through a referral system).

“All people have a right to have children if they want to, and the knowledge and support to do so safely,” Steiner says.—Christen Brownlee