AIDS and Behavior

, Volume 13, Supplement 1, pp 5–11 | Cite as

Strategies for Harm Reduction Among HIV-Affected Couples Who Want to Conceive

Review paper


As effective HIV treatments become more widespread, HIV-infected individuals are living longer, healthier lives. Many HIV-affected couples (sero-discordant and sero-concordant) are considering options for safer reproduction. A large body of evidence suggests that reproductive technologies can help HIV-affected couples to safely conceive with minimal risk of HIV transmission to their partner. However, for most couples such technologies are neither geographically nor economically accessible. This paper addresses the options for safer procreation among HIV-affected couples who cannot access reproductive technologies.


HIV Fertility Harm reduction Serodiscordant couples Reproductive health 


  1. Allen, S., Serufilira, A., Gruber, V., Kegeles, S., Van de Perre, P., Carael, M., et al. (1993). Pregnancy and contraception use among urban Rwandan women after HIV testing and counseling. American Journal of Public Health, 83(5), 705–710. doi:10.2105/AJPH.83.5.705.PubMedCrossRefGoogle Scholar
  2. Allen, S., Meinzen-Derr, J., Kautzman, M., Zulu, I., Trask, S., Fideli, U., et al. (2003). Sexual behavior of HIV discordant couples after HIV counseling and testing. AIDS (London, England), 17(5), 733–740. doi:10.1097/00002030-200303280-00012.Google Scholar
  3. American College of Obstetrics and Gynecology (ACOG): ethics committee. (2007). Human immunodeficiency virus. Obstetrics and Gynecology, 110(6), 1473–1478.Google Scholar
  4. Auvert, B., Taljaard, D., Lagarde, E., Sobngwi-Tambekou, J., Sitta, R., & Puren, A. (2005). Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 trial. PLoS Medicine, 2(11), e298. doi:10.1371/journal.pmed.0020298.PubMedCrossRefGoogle Scholar
  5. Bailey, R. C., Moses, S., Parker, C. B., Agot, K., Maclean, I., Krieger, J. N., et al. (2007). Male circumcision for HIV prevention in young men in Kisumu, Kenya: A randomised controlled trial. Lancet, 369(9562), 643–656. doi:10.1016/S0140-6736(07)60312-2.PubMedCrossRefGoogle Scholar
  6. Barreiro, P., del Romero, J., Leal, M., Hernando, V., Asencio, R., de Mendoza, C., et al. (2006). Natural pregnancies in HIV-serodiscordant couples receiving successful antiretroviral therapy. Journal of Acquired Immune Deficiency Syndromes, 43(3), 324–326. doi:10.1097/01.qai.0000243091.40490.fd.PubMedCrossRefGoogle Scholar
  7. Barreiro, P., Castilla, J. A., Labarga, P., & Soriano, V. (2007). Is natural conception a valid option for HIV-serodiscordant couples? Human Reproduction (Oxford, England), 22(9), 2353–2358. doi:10.1093/humrep/dem226.CrossRefGoogle Scholar
  8. Barroso, P. F., Schechter, M., Gupta, P., Melo, M. F., Vieira, M., Murta, F. C., et al. (2000). Effect of antiretroviral therapy on HIV shedding in semen. Annals of Internal Medicine, 133(4), 280–284.PubMedGoogle Scholar
  9. Bujan, L., Hollander, L., Coudert, M., Gilling-Smith, C., Vucetich, A., Guibert, J., et al. (2007). Safety and efficacy of sperm washing in HIV-1-serodiscordant couples where the male is infected: Results from the European CREAThE network. AIDS (London, England), 21(14), 1909–1914. doi:10.1097/QAD.0b013e3282703879.Google Scholar
  10. Castilla, J., Del Romero, J., Hernando, V., Marincovich, B., Garcia, S., & Rodriguez, C. (2005). Effectiveness of highly active antiretroviral therapy in reducing heterosexual transmission of HIV. Journal of Acquired Immune Deficiency Syndromes, 40(1), 96–101. doi:10.1097/01.qai.0000157389.78374.45.PubMedCrossRefGoogle Scholar
  11. CCNE. (1998). Opinion on ethical questions raised when a couple, in which the man is HIV-positive and the woman is HIV-negative, wish to bear a child (Vol. 56). France: National Consultative Ethics Committee for Health and Life Sciences.Google Scholar
  12. CDC. (1985). Recommendations for assisting in the prevention of perinatal transmission of human T-lymphotropic virus type III/lymphadenopathy-associated virus and acquired immunodeficiency syndrome. MMWR Morbidity and Mortality Weekly Report, 34(48), 721–726, 731–732.Google Scholar
  13. CDC. (1990). HIV-1 infection and artificial insemination with processed semen. MMWR Morbidity and Mortality Weekly Report, 39(15), 249, 255–256.Google Scholar
  14. CDC. (2001). Revised guidelines for HIV counseling, testing, and referral. MMWR Recommendations and reports, 50(RR-19), 1–57.Google Scholar
  15. Chen, J. L., Philips, K. A., Kanouse, D. E., Collins, R. L., & Miu, A. (2001). Fertility desires and intentions of HIV-positive men and women. Family Planning Perspectives, 33(4), 144–152.PubMedCrossRefGoogle Scholar
  16. de Bruyn, M. (2004). Living with HIV: Challenges in reproductive health care in South Africa. African Journal of Reproductive Health, 8(1), 92–98. doi:10.2307/3583312.PubMedCrossRefGoogle Scholar
  17. de Vincenzi, I. (1994). A longitudinal study of human immunodeficiency virus transmission by heterosexual partners. European study group on heterosexual transmission of HIV. The New England Journal of Medicine, 331(6), 341–346. doi:10.1056/NEJM199408113310601.PubMedCrossRefGoogle Scholar
  18. Drucker, E., Nadelmann, E., Newman, R. G., Wodak, A., McNeely, J., Malinowska-Semprucht, K., et al. (2005). Harm reduction: Pragmatic drug policies for public health and safety. In J. Lowinson, P. Ruiz, R. B. Millman, & J. G. Langrod (Eds.), Substance abuse: A comprehensive textbook (4th ed., pp. 1229–1249). Baltimore: Williams & Wilkins.Google Scholar
  19. Ethics Committee of the American Society of Reproductive Medicine. (2002). Human immunodeficiency virus and infertility treatment. Fertility and Sterility, 77(2), 218–222. doi:10.1016/S0015-0282(01)03000-X.CrossRefGoogle Scholar
  20. Frodsham, L. C., Boag, F., Barton, S., & Gilling-Smith, C. (2006). Human immunodeficiency virus infection and fertility care in the United Kingdom: Demand and supply. Fertility and Sterility, 85(2), 285–289. doi:10.1016/j.fertnstert.2005.07.1326.PubMedCrossRefGoogle Scholar
  21. Gnoth, C., Godehardt, E., Frank-Herrmann, P., Friol, K., Tigges, J., & Freundl, G. (2005). Definition and prevalence of subfertility and infertility. Human Reproduction (Oxford, England), 20(5), 1144–1147. doi:10.1093/humrep/deh870.CrossRefGoogle Scholar
  22. Gray, R. H., Kigozi, G., Serwadda, D., Makumbi, F., Watya, S., Nalugoda, F., et al. (2007). Male circumcision for HIV prevention in men in Rakai, Uganda: A randomised trial. Lancet, 369(9562), 657–666. doi:10.1016/S0140-6736(07)60313-4.PubMedCrossRefGoogle Scholar
  23. Grosskurth, H., Gray, R., Hayes, R., Mabey, D., & Wawer, M. (2000). Control of sexually transmitted diseases for HIV-1 prevention: Understanding the implications of the Mwanza and Rakai trials. Lancet, 355(9219), 1981–1987. doi:10.1016/S0140-6736(00)02336-9.PubMedCrossRefGoogle Scholar
  24. Gruskin, S., Ferguson, L., & O’Malley, J. (2007). Ensuring sexual and reproductive health for people living with HIV: An overview of key human rights, policy and health systems issues. Reproductive Health Matters, 15(29, Suppl), 4–26. doi:10.1016/S0968-8080(07)29028-7.PubMedCrossRefGoogle Scholar
  25. HFEA.(2003). HIV and IVF. London: Human Fertilisation and Embryology Authority. accessed September 1, 2008.
  26. Hugonnet, S., Mosha, F., Todd, J., Mugeye, K., Klokke, A., Ndeki, L., et al. (2002). Incidence of HIV infection in stable sexual partnerships: A retrospective cohort study of 1802 couples in Mwanza region, Tanzania. Journal of Acquired Immune Deficiency Syndromes, 30(1), 73–80. doi:10.1097/00126334-200205010-00010.PubMedCrossRefGoogle Scholar
  27. Lewis, J. J., Ronsmans, C., Ezeh, A., & Gregson, S. (2004). The population impact of HIV on fertility in sub-Saharan Africa. AIDS (London, England), 18(Suppl 2), S35–S43. doi:10.1097/00002030-200406002-00005.Google Scholar
  28. Madhavan, S. (2004). Fosterage patterns in the age of AIDS: Continuity and change. Social Science and Medicine, 58(7), 1443–1454. doi:10.1016/S0277-9536(03)00341-1.PubMedCrossRefGoogle Scholar
  29. Maier, M., Andia, I., Emenyonu, N., Guzman, D., Kaida, A., Pepper, L., Hogg, R., & Bangsberg, D.R. (2008). Antiretroviral Therapy is Associated with Increased Fertility Desire, but not Pregnancy or Live Birth, among HIV+ Women in an Early HIV Treatment Program in Rural Uganda. AIDS Behav. doi:10.1007/s10461-008-9371-7.
  30. Mandelbrot, L., Heard, I., Henrion-Geant, E., & Henrion, R. (1997). Natural conception in HIV-negative women with HIV-infected partners. Lancet, 349(9055), 850–851. doi:10.1016/S0140-6736(05)61754-0.PubMedCrossRefGoogle Scholar
  31. Marcelin, A. G., Tubiana, R., Lambert-Niclot, S., Lefebvre, G., Dominguez, S., Bonmarchand, M., et al. (2008). Detection of HIV-1 RNA in seminal plasma samples from treated patients with undetectable HIV-1 RNA in blood plasma. AIDS (London, England), 22(13), 1677–1679. doi:10.1097/QAD.0b013e32830abdc8.Google Scholar
  32. Mocroft, A., Vella, S., Benfield, T. L., Chiesi, A., Miller, V., Gargalianos, P., et al. (1998). Changing patterns of mortality across Europe in patients infected with HIV-1. EuroSIDA study group. Lancet, 352(9142), 1725–1730. doi:10.1016/S0140-6736(98)03201-2.PubMedCrossRefGoogle Scholar
  33. Myer, L., Morroni, C., & Rebe, K. (2007). Prevalence and determinants of fertility intentions of HIV-infected women and men receiving antiretroviral therapy in South Africa. AIDS Patient Care and STDs, 21(4), 278–285. doi:10.1089/apc.2006.0108.PubMedCrossRefGoogle Scholar
  34. Nebie, Y., Meda, N., Leroy, V., Mandelbrot, L., Yaro, S., Sombie, I., et al. (2001). Sexual and reproductive life of women informed of their HIV seropositivity: A prospective cohort study in Burkina Faso. Journal of Acquired Immune Deficiency Syndromes, 28(4), 367–372.PubMedGoogle Scholar
  35. O’Brien, J. E., Bryant, A., & Milad, M. (2006). P629: Assisted reproductive treatments versus unprotected intercourse to achieve pregnancy for HIV serodiscordant couples: A cost-effectiveness analysis. Fertility and Sterility, 86(3: Suppl 1), S366–S367.CrossRefGoogle Scholar
  36. Paiva, V., Filipe, E. V., Santos, N., Lima, T. N., & Segurado, A. (2003). The right to love: The desire for parenthood among men living with HIV. Reproductive Health Matters, 11(22), 91–100. doi:10.1016/S0968-8080(03)02293-6.PubMedCrossRefGoogle Scholar
  37. Palella, F. J., Jr, Delaney, K. M., Moorman, A. C., Loveless, M. O., Fuhrer, J., Satten, G. A., et al. (1998). Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV outpatient study investigators. The New England Journal of Medicine, 338(13), 853–860. doi:10.1056/NEJM199803263381301.PubMedCrossRefGoogle Scholar
  38. Panozzo, L., Battegay, M., Friedl, A., & Vernazza, P. L. (2003). High risk behaviour and fertility desires among heterosexual HIV-positive patients with a serodiscordant partner–two challenging issues. Swiss Medical Weekly, 133(7–8), 124–127.PubMedGoogle Scholar
  39. Peterson, L., Taylor, D., Roddy, R., Belai, G., Phillips, P., Nanda, K., et al. (2007). Tenofovir disoproxil fumarate for prevention of HIV infection in women: A phase 2, double-blind, randomized, placebo-controlled trial. PLoS Clinical Trials, 2(5), e27. doi:10.1371/journal.pctr.0020027.PubMedCrossRefGoogle Scholar
  40. Plummer, F. A., Simonsen, J. N., Cameron, D. W., Ndinya-Achola, J. O., Kreiss, J. K., Gakinya, M. N., et al. (1991). Cofactors in male-female sexual transmission of human immunodeficiency virus type 1. The Journal of Infectious Diseases, 163(2), 233–239.PubMedGoogle Scholar
  41. Politch, J., & Anderson, D. J. (2002). Preventing HIV-1 infection in women. Infertility and Reproductive Medicine Clinics, 13(1), 249–262.Google Scholar
  42. Quinn, T. C., Wawer, M. J., Sewankambo, N., Serwadda, D., Li, C., Wabwire-Mangen, F., et al. (2000). Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai prroject study group. The New England Journal of Medicine, 342(13), 921–929. doi:10.1056/NEJM200003303421303.PubMedCrossRefGoogle Scholar
  43. Roland, M. E., Martin, J. N., Grant, R. M., Hellmann, N. S., Bamberger, J. D., Katz, M. H., et al. (2001). Postexposure prophylaxis for human immunodeficiency virus infection after sexual or injection drug use exposure: Identification and characterization of the source of exposure. The Journal of Infectious Diseases, 184(12), 1608–1612. doi:10.1086/324580.PubMedCrossRefGoogle Scholar
  44. Rutstein, S. O., & Shah, I. H. (2004). Infecundity, infertility and childlessness in developing countries. Calverton: ORC Macro.Google Scholar
  45. Ryder, R. W., Kamenga, C., Jingu, M., Mbuyi, N., Mbu, L., & Behets, F. (2000). Pregnancy and HIV-1 incidence in 178 married couples with discordant HIV-1 serostatus: Additional experience at an HIV-1 counseling centre in the Democratic Republic of the Congo. Tropical Medicine & International Health, 5(7), 482–487. doi:10.1046/j.1365-3156.2000.00582.x.CrossRefGoogle Scholar
  46. Sauer, M. V. (2003). Providing fertility care to those with HIV: Time to re-examine healthcare policy. The American Journal of Bioethics, 3(1), 33–40. doi:10.1162/152651603321611944.PubMedCrossRefGoogle Scholar
  47. Semprini, A. E., Fiore, S., & Pardi, G. (1997). Reproductive counselling for HIV-discordant couples. Lancet, 349(9062), 1401–1402. doi:10.1016/S0140-6736(05)63250-3.PubMedCrossRefGoogle Scholar
  48. Serwadda, D., Gray, R. H., Wawer, M. J., Stallings, R. Y., Sewankambo, N. K., Konde-Lule, J. K., et al. (1995). The social dynamics of HIV transmission as reflected through discordant couples in rural Uganda. AIDS (London, England), 9(7), 745–750. doi:10.1097/00002030-199507000-00012.Google Scholar
  49. Sonko, S. (1994). Fertility and culture in Sub-Saharan Africa: A review. International Social Science Journal, 46(3), 397–411.Google Scholar
  50. Stanitis, J. A., Grow, D. R., & Wiczyk, H. (2008). Fertility services for human immunodeficiency virus-positive patients: Provider policy, practice, and perspectives. Fertility and Sterility, 89(5), 1154–1158. doi:10.1016/j.fertnstert.2007.05.017.PubMedCrossRefGoogle Scholar
  51. Stephenson, J. M., & Griffioen, A. (1996). The effect of HIV diagnosis on reproductive experience. Study group for the medical research council collaborative study of women with HIV. AIDS (London, England), 10(14), 1683–1687.Google Scholar
  52. Tuomala, R. E., O’Driscoll, P. T., Bremer, J. W., Jennings, C., Xu, C., Read, J. S., et al. (2003). Cell-associated genital tract virus and vertical transmission of human immunodeficiency virus type 1 in antiretroviral-experienced women. The Journal of Infectious Diseases, 187(3), 375–384. doi:10.1086/367706.PubMedCrossRefGoogle Scholar
  53. Vernazza, P. L., Troiani, L., Flepp, M. J., Cone, R. W., Schock, J., Roth, F., et al. (2000). Potent antiretroviral treatment of HIV-infection results in suppression of the seminal shedding of HIV. The Swiss HIV cohort study. AIDS (London, England), 14(2), 117–121. doi:10.1097/00002030-200001280-00006.Google Scholar
  54. Vernazza, P., Breener, I., & Graf, I. (2007). Pre-exposure prophylaxis and timed intercourse for HIV-discordant couples willing to conceive a child. Paper presented at the 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention.Google Scholar
  55. Vittinghoff, E., Scheer, S., O’Malley, P., Colfax, G., Holmberg, S. D., & Buchbinder, S. P. (1999). Combination antiretroviral therapy and recent declines in AIDS incidence and mortality. The Journal of Infectious Diseases, 179(3), 717–720. doi:10.1086/314623.PubMedCrossRefGoogle Scholar
  56. Wawer, M. J., Gray, R. H., Sewankambo, N. K., Serwadda, D., Paxton, L., Berkley, S., et al. (1998). A randomized, community trial of intensive sexually transmitted disease control for AIDS prevention, Rakai, Uganda. AIDS (London, England), 12(10), 1211–1225. doi:10.1097/00002030-199810000-00014.Google Scholar
  57. Wawer, M. J., Gray, R. H., Sewankambo, N. K., Serwadda, D., Li, X., Laeyendecker, O., et al. (2005). Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda. The Journal of Infectious Diseases, 191(9), 1403–1409. doi:10.1086/429411.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Division of Infectious DiseaseBeth Israel Deaconess Medical CenterBostonUSA
  2. 2.Division of Global Health EquityBrigham and Women’s HospitalBostonUSA

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