AIDS and Behavior

, Volume 15, Issue 2, pp 469–478 | Cite as

Life After HIV: Examination of HIV Serodiscordant Couples’ Desire to Conceive Through Assisted Reproduction

Original Paper


The current study addresses fertility desires and considerations among 143 HIV serodiscordant, opposite-sex couples (in which only the male partner is HIV positive) in the Northeastern U.S. Couples responded to questionnaires during their initial consultation for assisted reproduction, and data were collected over 7 years and analyzed retrospectively. Results indicated that a majority of the male participants had HIV when they met their partner, and a majority also disclosed their HIV status upon meeting. Most couples reported that they had previously discussed or considered a host of fertility-related issues, including the potential risk of HIV infection to the mother and the fetus during the process of fertility treatment. The majority of couples had also discussed the possibility that the male partner could die prematurely due to HIV/AIDS and had considered making arrangements for third-party parenting in the event of the male partner’s death. If their fertility treatment were to be successful in the future, most couples desired additional children, and most believed that their future child should be told of the male partner’s HIV status. Predictors of the desire for additional children after successful fertility treatment included: younger age, shorter relationship duration, being childless currently, and beginning their relationship after the male partner had already been diagnosed as HIV positive. Future research on fertility desires should include perspectives of HIV positive men on fatherhood, as well as concerns and issues specific to HIV serodiscordant couples.


Fertility desire HIV/AIDS Discordant couples Assisted reproduction HIV disclosure 


  1. 1.
    Quinn TC. HIV epidemiology and the effects of antiviral therapy on long-term consequences. AIDS. 2008;22(Suppl 3):S7–12.CrossRefPubMedGoogle Scholar
  2. 2.
    Department of Health and Human Services. HIV/AIDS surveillance report: cases of HIV infection and AIDS in the United States and dependent areas. (2007). Accessed 11 Feb 2010.
  3. 3.
    Harrison KM, Song R, Zhang X. Life expectancy after HIV diagnosis based on national HIV surveillance data from 25 states, United States. J Acquir Immune Defic Syndr. 2010;53(1):124–30.CrossRefPubMedGoogle Scholar
  4. 4.
    Gilling-Smith C, Nicopoullos JDM, Semprini AE, Frodsham LCG. HIV and reproductive care—a review of current practice. BJOG. 2006;113(8):869–78.CrossRefPubMedGoogle Scholar
  5. 5.
    van Leeuwen E, Repping S, Prins JM, Reiss P, van der Veen F. Assisted reproductive technologies to establish pregnancies in couples with an HIV-1-infected man. Neth J Med. 2009;67(8):322–7.PubMedGoogle Scholar
  6. 6.
    Sauer MV. Sperm washing techniques address the fertility needs of HIV-seropositive men: a clinical review. Reprod Biomed Online. 2005;10(1):135–40.CrossRefPubMedGoogle Scholar
  7. 7.
    Savasi V, Ferrazzi E, Lanzani C, Oneta M, Parrilla B, Persico T. Safety of sperm washing and ART outcome in 741 HIV-serodiscordant couples. Hum Reprod. 2007;22:772–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Bujan L, Hollander L, Coudert M, et al. Safety and efficacy of sperm washing in HIV-1-serodiscordant couples where the male is infected: results from the European CREAThE network. AIDS. 2007;21(14):1909–14.CrossRefPubMedGoogle Scholar
  9. 9.
    Cooper D, Moodley J, Zweigenthal V, Bekker LG, Shah I, Myer L. Fertility intentions and reproductive health care needs of people living with HIV in Cape Town, South Africa: implications for integrating reproductive health and HIV care services. AIDS Behav. 2009;13(Suppl 1):S38–46.CrossRefGoogle Scholar
  10. 10.
    Maier M, Andia I, Emenyonu N, et al. 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. 2009;13(Suppl 1):S28–37.CrossRefGoogle Scholar
  11. 11.
    Smith DJ, Mbakwem BC. Life projects and therapeutic itineraries: marriage, fertility, and antiretroviral therapy in Nigeria. AIDS. 2007;21(suppl 5):S37–41.CrossRefPubMedGoogle Scholar
  12. 12.
    Nattabi B, Li J, Thompson SC, Orach CG, Earnest J. A systematic review of factors influencing fertility desires and intentions among people living with HIV/AIDS: implications for policy and service delivery. AIDS Behav. 2009;13:949–68.CrossRefPubMedGoogle Scholar
  13. 13.
    Barnes DB, Murphy S. Reproductive decisions for women with HIV: motherhood’s role in envisioning a future. Qual Health Res. 2009;19(4):481–91.CrossRefPubMedGoogle Scholar
  14. 14.
    Craft SM, Delaney RO, Bautista DT, Serovich JM. Pregnancy decisions among women with HIV. AIDS Behav. 2007;11(6):927–35.CrossRefPubMedGoogle Scholar
  15. 15.
    Finocchario-Kessler S, Sweat MD, Dariotis JK, et al. Understanding high fertility desires and intentions among a sample of urban women living with HIV in the United States. AIDS Behav (Internet). 2009 Nov 12. doi:10.1007/s10461-009-9637-8. Accessed 22 Jan 2010.
  16. 16.
    Loutfy MR, Hart TA, Mohammed SS, et al. Fertility desires and intentions of HIV-positive women of reproductive age in Ontario, Canada: a cross-sectional study. PLoS ONE. 2009;4(12):e7925.CrossRefPubMedGoogle Scholar
  17. 17.
    Nobrega AA, Oliveira FAS, Galvao MTG, et al. Desire for a child among women living with HIV/AIDS in Northeast Brazil. AIDS Patient Care STDS. 2007;21(4):261–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Stanwood NL, Cohn SE, Heiser JR, Pugliese MA. Contraception and fertility plans in a cohort of HIV-positive women in care. Contraception. 2007;75(4):294–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Sowell RL, Murdaugh CL, Addy CL, Moneyham L, Tavokoli A. Factors influencing intent to get pregnant in HIV-infected women living in the southern USA. AIDS Care. 2002;14(2):181–91.CrossRefPubMedGoogle Scholar
  20. 20.
    Richter DL, Sowell RL, Pluto DM. Factors affecting reproductive decisions of African American women living with HIV. Women Health. 2002;36(1):81–96.CrossRefPubMedGoogle Scholar
  21. 21.
    Cooper D, Harries J, Myer L, Orner P, Bracken H. Life is still going on: reproductive intentions among HIV-positive women and men in South Africa. Soc Sci Med. 2007;65(2):274–83.CrossRefPubMedGoogle Scholar
  22. 22.
    Johnson KB, Akwara P, Rutstein SO, Bernstein S. Fertility preferences and the need for contraception among women living with HIV: the basis for a joint action agenda. AIDS. 2009;23(Suppl 1):S7–17.CrossRefPubMedGoogle Scholar
  23. 23.
    Yeatman SE. The impact of HIV status and perceived status on fertility desires in rural Malawi. AIDS Behav. 2009;13(Suppl 1):S12–9.CrossRefGoogle Scholar
  24. 24.
    Taulo F, Berry M, Tsui A, et al. Fertility intentions of HIV-1 infected and uninfected women in Malawi: a longitudinal study. AIDS Behav. 2009;13(Suppl 1):S20–7.CrossRefGoogle Scholar
  25. 25.
    Tamene W, Fantahun M. Fertility desire and family-planning demand among HIV-positive women and men undergoing antiretroviral treatment in Addis Ababa, Ethiopia. Afr J AIDS Res. 2007;6(3):223–7.CrossRefGoogle Scholar
  26. 26.
    Beyeza-Kashesya J, Ekstrom AM, Kaharuza F, Mirembe F, Neema S, Kulane A. My partner wants a child: a cross-sectional study of the determinants of the desire for children among mutually disclosed sero-discordant couples receiving care in Uganda. BMC Public Health. 2010;10:247.CrossRefPubMedGoogle Scholar
  27. 27.
    Oladapo OT, Daniel OJ, Odusoga OL, Ayoola-Sotubo O. Fertility desires and intentions of HIV-positive patients at a suburban specialist center. J Natl Med Assoc. 2005;97(12):1672–81.PubMedGoogle Scholar
  28. 28.
    Chen JL, Phillips KA, Kanouse DE, Collins RL, Miu A. Fertility desires and intentions of HIV-positive men and women. Fam Plann Perspect. 2001;33(4):144–52. & 165.CrossRefPubMedGoogle Scholar
  29. 29.
    Heard I, Sitta R, Lert F, VESPA Study Group. Reproductive choice in men and women living with HIV: evidence from a large representative sample of outpatients attending French hospitals. AIDS. 2007;21(Suppl 1):S77–82.CrossRefPubMedGoogle Scholar
  30. 30.
    Wesley Y. Desire for children among black women with and without HIV infection. J Nurs Scholars. 2003;35(1):37–43.CrossRefGoogle Scholar
  31. 31.
    Matthews LT, Mukherjee JS. Strategies for harm reduction among HIV-affected couples who want to conceive. AIDS Behav. 2009;13(Suppl 1):S5–11.CrossRefGoogle Scholar
  32. 32.
    Klein J, Pena JE, Thornton MH, Sauer MV. Understanding the motivations, concerns, and desires of human immunodeficiency virus 1-serodiscordant couples wishing to have children through assisted reproduction. Obstet Gynecol. 2003;101(5):987–94.CrossRefPubMedGoogle Scholar
  33. 33.
    Asander AS, Bjorkman A, Belfrage E, Faxelid E. HIV-infected African parents living in Stockholm, Sweden: disclosure and planning for their children’s future. Health Soc Work. 2009;34(2):107–15.PubMedGoogle Scholar
  34. 34.
    Bogart LM, Cowgill BO, Kennedy D, et al. HIV-related stigma among people with HIV and their families: a qualitative analysis. AIDS Behav. 2008;12:224–54.CrossRefGoogle Scholar
  35. 35.
    Arnold EM, Rice E, Flannery D, Rotheram-Borus MJ. HIV disclosure among adults living with HIV. AIDS Care. 2008;20(1):80–92.CrossRefGoogle Scholar
  36. 36.
    Sowell RL, Seals BF, Phillips KD, Julious CH. Disclosure of HIV infection: how do women decide to tell? Health Educ Res. 2003;18(1):32–44.CrossRefPubMedGoogle Scholar
  37. 37.
    Crepaz N, Marks G. Serostatus disclosure, sexual communication and safer sex in HIV-positive men. AIDS Care. 2003;15(3):379–87.CrossRefPubMedGoogle Scholar
  38. 38.
    Sullivan K. Male self-disclosure of HIV infection to sex partners: a Hawaii-based sample. J Assoc Nurses AIDS Care. 2009;20(6):442–57.CrossRefPubMedGoogle Scholar
  39. 39.
    Duru OK, Collins RL, Ciccarone DH, et al. Correlates of sex without serostatus disclosure among a national probability sample of HIV patients. AIDS Behav. 2006;10:495–507.CrossRefPubMedGoogle Scholar
  40. 40.
    Kennedy DP, Cowgill BO, Bogart LM, et al. Parents’ disclosure of their HIV infection to their children in the context of the family. AIDS Behav (Internet). 2010 May 28. doi:10.1007/s10461-010-9715-y. Accessed 1 Jul 2010.
  41. 41.
    Lee MB, Rotheram-Borus MJ. Parents’ disclosure of HIV to their children. AIDS. 2002;16(16):2201–7.CrossRefPubMedGoogle Scholar
  42. 42.
    Nam SL, Fielding K, Avalos A, Gaolathe T, Dickinson D, Geissler PW. Discussing matters of sexual health with children: what issues relating to disclosure of parental HIV status reveal. AIDS Care. 2009;21(3):389–95.CrossRefPubMedGoogle Scholar
  43. 43.
    Delaney RO, Serovich JM, Lim JY. Reasons for and against maternal HIV disclosure to children and perceived child reaction. AIDS Care. 2008;20(7):876–80.CrossRefPubMedGoogle Scholar
  44. 44.
    Calin T, Green J, Hetherton J, Brook G. Disclosure of HIV among black African men and women attending a London HIV clinic. AIDS Care. 2007;19(3):385–91.CrossRefPubMedGoogle Scholar
  45. 45.
    Maman S, Mbwambo JK, Hogan NM, Weiss E, Kilonzo GP, Sweat MD. High rates and positive outcomes of HIV-serostatus disclosure to sexual partners: reasons for cautious optimism from a voluntary counseling and testing clinic in Dares Salaam, Tanzania. AIDS Behav. 2003;7(4):373–82.CrossRefPubMedGoogle Scholar
  46. 46.
    Nakayiwa S, Abang B, Packel L, et al. Desire for children and pregnancy risk behavior among HIV-infected men and women in Uganda. AIDS Behav. 2006;10(Suppl 4):S95–104.CrossRefPubMedGoogle Scholar
  47. 47.
    Myer L, Morroni C, Rebe K. Prevalence and determinants of fertility intentions of HIV-infected women and men receiving antiretroviral therapy in South Africa. AIDS Patient Care STDS. 2007;21(4):278–85.CrossRefPubMedGoogle Scholar
  48. 48.
    Peltzer K, Chao LW, Dana P. Family planning among HIV positive and negative prevention of mother to child transmission (PMTCT) clients in a resource poor setting in South Africa. AIDS Behav. 2009;13(5):973–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, College of Physicians and SurgeonsCenter for Women’s Reproductive Care, Columbia UniversityNew YorkUSA

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