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Realizing Women Living with HIV’s Reproductive Rights in the Era of ART: The Negative Impact of Non-consensual HIV Disclosure on Pregnancy Decisions Amongst Women Living with HIV in a Canadian Setting

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Abstract

To better understand the structural drivers of women living with HIV’s (WLWH’s) reproductive rights and choices, this study examined the structural correlates, including non-consensual HIV disclosure, on WLWH’s pregnancy decisions and describes access to preconception care. Analyses drew on data (2014-present) from SHAWNA, a longitudinal community-based cohort with WLWH across Metro-Vancouver, Canada. Multivariable logistic regression was used to model the effect of non-consensual HIV disclosure on WLWH’s pregnancy decisions. Of the 218 WLWH included in our analysis, 24.8% had ever felt discouraged from becoming pregnant and 11.5% reported accessing preconception counseling. In multivariable analyses, non-consensual HIV disclosure was positively associated with feeling discouraged from wanting to become pregnant (AOR 3.76; 95% CI 1.82–7.80). Non-consensual HIV disclosure adversely affects WLWH’s pregnancy decisions. Supporting the reproductive rights of WLWH will require further training among general practitioners on the reproductive health of WLWH and improved access to women-centred, trauma-informed care, including non-judgmental preconception counseling.

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Acknowledgments

We thank all those who contributed their time and expertise to this project, particularly participants, community partners, the SHAWNA Positive Women’s Advisory Board and Community Advisory Board, and the SHAWNA Project team: Sarah Moreheart, Brittany Udall, Jennifer Morris, Flo Ranville, Heidi Safford, Lauren Martin, Ray Croy, Bridgette Simpson, Anita Dhanoa, Monique Desroches, Lydia Hamel, Lulu Gurney, and Patience Chamboko. We also acknowledge Melissa Braschel, Abby Rolston, Sylvia Machat, Peter Vann, Erin Seatter, and Patricia McDonald for their research and administrative support. KS is supported by a Canada Research Chair in Global Sexual Health and HIV/AIDS and Michael Smith Foundation for Health Research. KS is supported by a Canada Research Chair in Global Sexual Health and HIV/AIDS and Michael Smith Foundation for Health Research. PD is supported by the Canadian Institutes for Health Research and Michael Smith Foundations for Health Research Postdoctoral Fellowship Award. JM received research support, paid to the institution, from the Public Health Agency of Canada, the BC-Ministry of Health, the US NIH (NIDA R01DA036307 and CTN 248), the Canadian Institutes of Health Research, Janssen & Janssen, and Merk.

Funding

This research was supported by the Canadian Institutes of Health Research (MOP-133617) and MacAIDS.

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Authors and Affiliations

  1. Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada

    Putu Duff, Mary Kestler, Patience Chamboko, Melissa Braschel, Andrea Krüsi & Kate Shannon

  2. Faculty of Medicine, St. Paul’s Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada

    Putu Duff, Mary Kestler, Julio Montaner, Deborah Money & Kate Shannon

  3. BC Women’s Hospital, 4500 Oak St, Vancouver, BC, V6H 3N1, Canada

    Putu Duff, Mary Kestler, Gina Ogilvie & Deborah Money

  4. Department of Obstetrics & Gynecology, University of British Columbia, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada

    Gina Ogilvie & Deborah Money

  5. School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada

    Gina Ogilvie, Andrea Krüsi & Kate Shannon

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  1. Putu Duff
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the SHAWNA Project

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Correspondence to Kate Shannon.

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Research Involving Human Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study holds ethical approval through Providence Health Care/University of British Columbia Research Ethics Board and BC Women’s Hospital.

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Informed consent was obtained from all individual participants included in the study.

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Duff, P., Kestler, M., Chamboko, P. et al. Realizing Women Living with HIV’s Reproductive Rights in the Era of ART: The Negative Impact of Non-consensual HIV Disclosure on Pregnancy Decisions Amongst Women Living with HIV in a Canadian Setting. AIDS Behav 22, 2906–2915 (2018). https://doi.org/10.1007/s10461-018-2111-8

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