In this study, we found that the predictors of fertility intention of women with HIV were age, ethnicity and marital status. Women who were HIV-positive described an intention to have children at levels approaching those among the general population and regardless of their clinical HIV status. Public policy planners and health practitioners need to consider and plan for the implications of increased numbers of women with HIV who may choose to have children.

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Introduction: We aimed to give a global overview of trends in access to sexual and reproductive health and rights (SRHR) during the Covid-19 pandemic and what is being done to mitigate its impact. Material and methods: We performed a descriptive analysis and content analysis based on an online survey among clinicians, researchers and organizations. Our data was extracted from multiple-choice questions on access to SRHR services and risk of SRHR violations, and written responses to open-ended questions on threats to access and required response. Results: The survey was answered by 51 people representing 29 countries. 86% reported that access to contraceptive services was less or much less due to Covid-19, corresponding figures for surgical and medical abortion were 62% and 46%. The increased risk of gender-based and sexual violence was assessed as moderate or severe by 79%. Among countries with mildly restrictive abortion policies, 69% had implemented changes to facilitate access to abortion during the pandemic, compared to 0 among countries with severe restrictions (p<0.001), 87.5% compared to 46% had implemented changes to facilitate access to contraception (p= 0.023). The content analysis showed that i) prioritizations in health service delivery at the expense of SRHR, ii) lack of political will, iii) the detrimental effect of lock-down, and iv) the suspension of sexual education, were threats to SRHR access (theme 1). Requirements to mitigate these threats (theme 2) were i) political will and support of universal access to SRH services, ii) the sensitization of providers, vii) free public transport, and viii) physical protective equipment. A contrasting third theme was the state of exception of the Covid-19 pandemic as a window of opportunity to push forward women´s health and rights. Conclusions: Many countries have seen decreased access to and increased violations of SRHR during the Covid-19 pandemic. Countries with severe restrictions on abortion seem less likely to have implemented changes to SRHR delivery to mitigate this impact. Political will to support the advancement of SRHR is often lacking, which is fundamental to ensuring both continued access and, in a minority of cases, the solidification of gains made to SRHR during the pandemic.

BackgroundWomen living with HIV (WHIV) are disproportionately impacted by cervical dysplasia and cancer. The burden is greatest in low-income countries where limited or no access to screening exists. The goal of this study was to describe knowledge and intentions of WHIV towards HPV self-collection for cervical cancer screening, and to report on factors related to HPV positivity among women who participated in testing.MethodsA validated survey was administered to 87 HIV positive women attending the Kisenyi Health Unit aged 30–69 years old, and data was abstracted from chart review. At a later date, self-collection based HPV testing was offered to all women. Specimens were tested for high risk HPV genotypes, and women were contacted with results and referred for care. Descriptive statistics, Chi Square and Fischer-exact statistical tests were performed.ResultsThe vast majority of WHIV (98.9%) women did not think it necessary to be screened for cervical cancer and the majority of women had never heard of HPV (96.4%). However, almost all WHIV found self-collection for cervical cancer screening to be acceptable. Of the 87 WHIV offered self-collection, 40 women agreed to provide a sample at the HIV clinic. Among women tested, 45% were oncogenic HPV positive, where HPV 16 or 18 positivity was 15% overall.ConclusionsIn this group of WHIV engaged in HIV care, there was a high prevalence of oncogenic HPV, a large proportion of which were HPV genotypes 16 or 18, in addition to low knowledge of HPV and cervical cancer screening. Improved education and cervical cancer screening for WHIV are sorely needed; self-collection based screening has the potential to be integrated with routine HIV care in this setting.

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