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The right to choose parenthood among HIV-infected women and men

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Abstract

As life expectancy for HIV-infected persons improves, studies in sub-Saharan Africa show that a considerable proportion of HIV-positive women and men desire to have children. Integrating sexual and reproductive health care into HIV services has until now emphasized the right of women to make informed choices about their reproductive lives and the right of self-determination to reproduce, but this is often equated with avoidance of pregnancy. Here, we explore guidance and attention to safer conception for HIV-infected women and men. We find this right lacking. Current sexual and reproductive health guidelines are not proactive in supporting HIV-positive people desiring children, and are particularly silent about the fertility needs of HIV-infected men and uninfected men in discordant partnerships. Public health policymakers and providers need to engage the HIV-infected and uninfected to determine both the demand for and how best to address the need for safer conception services.

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Acknowledgements

Preparation of this article was supported by a National Institute of Mental Health grant, ‘A Structural Intervention to Integrate Reproductive Health into HIV Care’ (R01-MH078770; PI: Joanne E. Mantell, PhD); a center grant from the National Institute of Mental Health to the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University (P30-MH43520; Principal Investigator: Anke A. Ehrhardt, PhD); and a grant from the William and Flora Hewlett Foundation (2008–1940; Co-PI: Mags Beksinska, MSc and Jennifer Smit, PhD) to the Reproductive Health and HIV Research Unit of the University of the Witwatersrand. Ideas for this article were stimulated from discussions at a Seminar entitled ‘Managing the Sexual and Reproductive Health of HIV+ Women and Men: Emerging Issues and Technologies’, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University (P30-MH43520; PI: Anke A. Ehrhardt, PhD), New York, NY, 8–9 December 2009. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH, the National Institute of Mental Health, or the William and Flora Hewlett Foundation. The authors greatly appreciate the comments of the anonymous reviewers of this manuscript.

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Authors and Affiliations

  1. HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, Unit 15, New York, 10032, NY, USA

    Joanne E Mantell & Zena A Stein

  2. Reproductive Health and HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa

    Jennifer A Smit

  3. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

    Zena A Stein

  4. G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Zena A Stein

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  1. Joanne E Mantell
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  2. Jennifer A Smit
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  3. Zena A Stein
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Correspondence to Joanne E Mantell.

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Among the many vexing and contentious policy decisions facing public health is reproductive choice among those infected with HIV. These authors look beyond current sexual and reproductive health guidelines, which are not proactive in supporting HIV-positive people desiring children. They consider the fertility needs of HIV-infected and uninfected men and women in discordant partnerships to recommend relevant policies and practices.

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Mantell, J., Smit, J. & Stein, Z. The right to choose parenthood among HIV-infected women and men. J Public Health Pol 30, 367–378 (2009). https://doi.org/10.1057/jphp.2009.35

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