Fathers and HIV: considerations for families

Abstract

BackgroundFathers are intricately bound up in all aspects of family life. This review examines fathers in the presence of HIV: from desire for a child, through conception issues, to a summary of the knowledge base on fathers within families affected by HIV.MethodsA mixed-methods approach is used, given the scarcity of literature. A review is provided on paternal and male factors in relation to the desire for a child, HIV testing in pregnancy, fatherhood and conception, fatherhood and drug use, paternal support and disengagement, fatherhood and men who have sex with men (MSM), and paternal effects on child development in the presence of HIV. Literature-based reviews and systematic review techniques are used to access available data Primary data are reported on the issue of parenting for men who have sex with men.ResultsMen with HIV desire fatherhood. This is established in studies from numerous countries, although fatherhood desires may be lower for HIV-positive men than HIV-negative men. Couples do not always agree, and in some studies, male desires for a child are greater than those of their female partners. Despite reduced fertility, support and services, many proceed to parenting, whether in seroconcordant or serodiscordant relationships. There is growing knowledge about fertility options to reduce transmission risk to uninfected partners and to offspring.Within the HIV field, there is limited research on fathering and fatherhood desires in a number of difficult-to-reach groups. There are, however, specific considerations for men who have sex with men and those affected by drug use. Conception in the presence of HIV needs to be managed and informed to reduce the risk of infection to partners and children. Further, paternal support plays a role in maternal management.ConclusionsStrategies to improve HIV testing of fathers are needed. Paternal death has a negative impact on child development and paternal survival is protective. It is important to understand fathers and fathering and to approach childbirth from a family perspective.

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

“…A more recent study taking into account both heterosexual and gay/bisexual men yielded similar results (Sherr, 2010). Both studies report a reluctance of men to approach an HCP about this issue due to fear of discrimination (Sherr, 2010;Sherr & Barry, 2004). Our data showed that stigma and lack of access to healthcare resources were found to be the most important issues affecting conception planning for PLWHIV.…”

“…A 2004 study of HIV-positive heterosexual men in London, United Kingdom, found that although nearly half of the sample population desired to conceive, most were not given medical advice and felt uninformed about the issue (Sherr & Barry, 2004). A more recent study taking into account both heterosexual and gay/bisexual men yielded similar results (Sherr, 2010). Both studies report a reluctance of men to approach an HCP about this issue due to fear of discrimination (Sherr, 2010;Sherr & Barry, 2004).…”

“…Our 2009 study revealed that 57% of the 490 participating HIV-positive women of reproductive age in Ontario intended a future pregnancy (Loutfy et al, 2009). Interest in pregnancy exists not only among heterosexual HIV-positive women, but also among HIV-positive men with HIVnegative or HIV-positive female partners, and HIV-positive men and women who are single or with same-sex partners (Nobrega et al, 2007;Sherr, 2010;Sherr & Barry, 2004).…”

How the global call for elimination of pediatric HIV can support HIV-positive women to achieve their pregnancy intentions

“…57 The limited evidence on HIV-positive men's pregnancy intentions generally indicates that HIV-positive men tend to want children more than their HIV-positive female counterparts. [36][37][38]52,58 More research is needed to explore men's and couples' views on pregnancy desires in the context of HIV.…”

HIV positive men as fathers: Accounts of displacement, ir/responsibility and paternal emergence

“…However, accompanying the dramatic increase of HIV survival rates, particularly in high income countries since highly active antiretroviral therapy (HAART) was first introduced in 1996, an increasing number of HIV positive men are becoming fathers or are expressing interest in having children (Baumgartner and Niemi, 2013;Doyal et al 2009;Sherr, 2010).…”