Access to infertility services in Canada for HIV-positive individuals and couples: a cross-sectional study

Yudin, Mark H.; Shapiro, Heather; Loutfy, Mona

doi:10.1186/1742-4755-7-7

Cited by 28 publications

(36 citation statements)

References 21 publications

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“…Inadequate access to conception planning and assisted reproductive services has been documented in North America, Australia and the United Kingdom, despite the existence of guidelines for reproductive care for PLWHIV (Apoola et al, 2001;Cooper et al, 2009;Frodsham, Boag, Barton, & Gilling-Smith, 2006;Gruskin, Firestone, MacCarthy, & Ferguson, 2008;Minkoff, 2006;Pitts & Shields, 2004;Sauer, 2006;Stanitis, Brow, & Wiczyk, 2008;Yudin, Shapiro, & Loutfy, 2010). Our study showed that although 63% of participants intended a future pregnancy and 44% had a plan for conception in the near future, only 30% had spoken to an HCP about the issue and only 30% had some knowledge about conception planning and assisted reproductive services for safer conception.…”

Section: Discussioncontrasting

confidence: 57%

Access to conception planning information and services for people living with HIV in Ontario, Canada: A community-based research study

Huynh

Gysler

Loutfy

et al. 2012

Vulnerable Children and Youth Studies

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Decreased mortality, decreased risk of vertical HIV transmission, and many people living with HIV (PLWHIV) being of reproductive age have led many PLWHIV to consider pregnancy. However, scarce data exist regarding the conception planning resources required and available for PLWHIV to have safe and healthy pregnancies. This study aimed to identify gaps between the need for, knowledge of, and access to conception planning information and services among PLWHIV in Ontario, Canada. PLWHIV from three large and two small urban sites in Ontario were recruited (n = 63). Participants completed a cross-sectional survey assessing demographics, expectations and plans for conception, and knowledge about and access to existing conception information and services for PLWHIV. Univariate correlations and ranked analyses were used to assess the associations between the need for, knowledge of, and access to conception planning resources with various demographic variables. Participants' median age was 40 years (interquartile range = 33-45) with 52% being female, 73% identified as heterosexual, and 27% as lesbian, gay, bisexual, queer, transgender, two-spirited, or other. Univariable analysis indicated that male PLWHIV and those from small urban areas were less likely to expect children in the future and less likely to speak to healthcare providers about conception planning. Although 63% of all participants intended to conceive and 44% had a plan for conception in the near future, only 30% had spoken to a healthcare provider about pregnancy and only 30% had some knowledge about conception planning and assisted reproductive services for safer conception for PLWHIV. Knowledge of and access to resources on conception planning for PLWHIV varied by sexual orientation and geographic location in Ontario. Our results show a gap between the need for conception information and knowledge of and access to adequate information and resources among PLWHIV in Ontario, which may impact the psychosocial well-being of PLWHIV and their children.

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Section: Discussioncontrasting

confidence: 57%

Access to conception planning information and services for people living with HIV in Ontario, Canada: A community-based research study

Huynh

Gysler

Loutfy

et al. 2012

Vulnerable Children and Youth Studies

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“…Healthcare providers ought to consider adding a discussion about pregnancy planning, healthy pre-conception lifestyle, and contraception into routine HIV care to support safer pregnancies, maximizing the health of the women and their partners and protecting future children by reducing vertical transmission. In Canada, we are in the process of developing national guidelines on pregnancy planning as well as provincial and national HIV Fertility Programs [20,30,31]. We hope that our research and ongoing projects will assist HIV-positive individuals, policy makers and healthcare providers globally to develop their programmes for safer, supportive pregnancy and family planning for HIV-positive individuals in their communities.…”

Section: Discussionmentioning

confidence: 99%

High prevalence of unintended pregnancies in HIV‐positive women of reproductive age in Ontario, Canada: a retrospective study

et al. 2011

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There is speculation, but there are few data, on the high rates of unintended pregnancies in HIV-positive women. We investigated rates and correlates of unintended pregnancies among HIV-positive women of reproductive age. MethodsA cross-sectional study was conducted with recruitment stratified to match the geographical distribution of HIV-positive women of reproductive age (18-52 years) living in Ontario, Canada. Women, recruited from 38 sites between October 2007 and April 2009, were invited to complete a 189-item self-administered survey. This analysis focused on questions relating to pregnancy and whether the last pregnancy was intended. Logistic regression models were fitted to calculate unadjusted and adjusted odds ratios of correlates of unintended pregnancies occurring after HIV diagnosis. Happiness with unintended pregnancies was also assessed. ResultsThe median age at the time of the survey of the 416 participating HIV-positive women who were previously pregnant (53% before and 47% after HIV diagnosis) was 38 years [interquartile range (IQR) 33-44 years] and their last pregnancy was a median of 8 years (IQR 3-14 years) prior to the survey (n 5 283). Fifty-nine per cent were born outside Canada and 47% were of African ethnicity. Of the 416, 56% [95% confidence interval (CI) 51-61%] identified that their last pregnancy was unintended (57% before and 54% after HIV diagnosis). In the multivariable model, significant correlates of unintended pregnancy after HIV diagnosis were: marital status (P 5 0.01) and never having given birth (P 5 0.01). Women were less happy if their pregnancy was unintended (Po0.01). ConclusionsThe prevalence of unintended pregnancy was high in this cohort. Pregnancy planning programmes are needed for this population to decrease fetal and maternal complications and reduce vertical and horizontal transmission.

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“…However, access to reproductive treatment has been controversial, with few clinics globally engaging in practices to support this patient group (Yudin et al, 2010). It is therefore probable that many serodiscordant couples have unmet desires around their family intentions due to the scarcity of such programmes.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence also exists regarding differences between the fertility desires of positive men and women, with many studies finding that men were more likely to continue to desire children after they had learned about their HIV-positive status (Paiva, Filipe, Santos, Lima, & Segurado, 2003). While HIV requires individual adjustment and lifestyle modifications, it does not remove or eradicate the desire for a child or a family (Yudin, Shapiro, & Loufty, 2010).…”

Section: Introductionmentioning

confidence: 97%

A qualitative study of HIV serodiscordant patients accessing assisted reproductive treatment

Peak

Nowoweiski

Giles

2012

Journal of Reproductive and Infant Psychology

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Objective: To explore the medical and psychosocial experiences of HIV serodiscordant patients attending an Assisted Reproductive Treatment (ART) programme. Design: Twenty couples in treatment from June 2008 to June 2009 were sent written invitations to participate in the study. Method: A semi-structured interview investigating the client's HIV history, family decision-making, engagement with and experiences of the programme was conducted. Interviews were transcribed verbatim and thematic content analysis was used. Results: Six couples expressed an interest to participate in the study, with a final sample of 10 participants comprising of 4 couples and 2 individuals. Participants demonstrated varying levels of understanding in relation to the medical implications of treatment including vertical and horizontal transmission risks and ART procedures. Infertility-related stresses were highlighted including the quality of the couple's interpersonal relationships, the emotional, physical and financial burden of treatment and the impact of fertility treatment on their work/life balance. Disclosure of HIV status and managing confidentiality were also significant challenges for participants of this programme. Conclusion: Participants' experiences of the programme have been positive, though varied. They expressed high expectations of the programme, particularly regarding the likelihood of a pregnancy. HIV was not seen by the clients to be a clinical indicator for infertility.

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Access to infertility services in Canada for HIV-positive individuals and couples: a cross-sectional study

Cited by 28 publications

References 21 publications

Access to conception planning information and services for people living with HIV in Ontario, Canada: A community-based research study

Access to conception planning information and services for people living with HIV in Ontario, Canada: A community-based research study

High prevalence of unintended pregnancies in HIV‐positive women of reproductive age in Ontario, Canada: a retrospective study

A qualitative study of HIV serodiscordant patients accessing assisted reproductive treatment

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