Improving the quality of sexual and reproductive health and rights (SRHR) through pre-service training, research, and evidence-based clinical care delivery in Sub-Saharan Africa

Background
Young women living with HIV (YWLHIV) desire to bear children. However, conception through the traditional unprotected sexual intercourse carries a higher risk of sexual transmission of HIV to their male partners. Safer conception methods (SCMs) such as timed unprotected sexual intercourse coupled with the use of ARV drugs for the HIV-negative male partners, artificial insemination or invitro fertilization are promising methods for minimizing the HIV transmission risks during conception. Previous research on SCMs for WLHIV are scarce. We therefore set out to determine the YWLHIV’s fertility desires, reproductive goals, knowledge, perceptions and use of the SCMs. The findings can inform the development of reproductive health educational resources, and service delivery models for YWLHIV.

Methods
In a mixed-method design, a consecutive sample of YWLHIV from semi-rural northern Uganda attending antiretroviral therapy clinics were recruited into the study between November 2022 and April 2023. The participants first responded to a quantitative interviewer-administered questionnaire about the SCMs they know of and use. This was followed with a qualitative in-depth interview about their perceptions about the potential advantages, disadvantages, and challenges of SCMs for YWLHIV. Descriptive statistics, bivariate and multivariate Poisson regression analyses were used to establish the prevalence, associated factors and the predictors of knowledge about SCMs, respectively. The statistical significance level of 5% and 95% confidence interval were considered. Thematic analysis was used for the qualitative data.

Results
A total of 423 YWLHIV aged 21.6 ±2.5 years participated in the study. We found 53.2% level of knowledge about SCMs among the YWLHIV. The predictors of knowledge about SCMs include having low educational attainment, knowledge of the HIV discordant status, access to information about contraception methods, and having the correct perceptions about the benefits of the SCMs. Qualitative data revealed that some of the YWLHIV held correct perceptions about the benefits of the SCMs including its ability to prevent cross infections. Fear of the risk of sexual transmission of HIV to male partners emerged as a concern on the SCMs that involves the use of timed unprotected intercourse with ARV drugs for the HIV-negative male partner. The fears were based on the possibilities of ARV drug failure, lack of cooperation and poor adherence to the ARV drug regimens among the male partners.

Conclusions
About 1 in 2 WHLHIV in semi-rural northern Uganda have correct knowledge about the SCMs with minimal or no risk of HIV transmission to their male partners for YWLHIV. The predictors of knowledge about the SCMs included the women’s knowledge of their HIV discordant status, access to information about contraception methods, and having correct perceptions about the benefits of the SCMs. Messages about the benefits of safer conception methods, HIV testing, use of ARV drugs as treatment, PrEP or PEP and modern contraceptive methods should be emphasized during reproductive health education and counselling for YWLHIV in an integrated manner. Furthermore, routine HIV prevention, care and treatment programs should embrace strategies for improving the male partner’s cooperation and adherence on ARV drug regimens as part of safer conception services.