East meets West: Management of women living with HIV

Women for Positive Action at the 13th European AIDS Conference, Belgrade, October 12-15, 2011

Women for Positive Action were invited to participate in a mini-lecture at the European AIDS Conference in Belgrade as part of the session ‘When people living with HIV grow up to become adults or want children’. Speaking on behalf of the faculty, Dr Teresa Branco (Portugal) and Dr Mariana Mărdărescu (Romania) presented an overview of the challenges facing women living with HIV who wish to start a family, specifically focussing on differences across Europe.

The epidemiology across the European region was discussed, highlighting that while the number of new diagnoses in western and central Europe is stabilising, it is still rising in eastern Europe. Dr Branco confirmed that in Portugal approximately 26% of the 40,235 people living with HIV are women and 1,156 of these were diagnosed during pregnancy. The principal modes of transmission in Portugal are heterosexual intercourse and intravenous drug use.

Dr Mărdărescu highlighted that in Romania those children who contracted HIV during the late 1980s are now in early adulthood, many of whom are in stable relationships, often with an HIV-negative partner and now wish to start a family. In Romania, the main mode of HIV transmission is also through heterosexual intercourse and in 2010 there were a total of 10,405 people living with HIV/AIDS.

For those living with HIV who wish to start a family the key assisted fertility techniques available include intrauterine insemination (IUI), in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) following sperm washing. Availability of these assisted fertility services varies largely across Europe irrespective of east, west, north and south, and access to these services mainly depends on whether they are privately or publically funded.

The information on the access to these services is limited and is included in few regional or national guidelines. Furthermore, adoption is either not available for couples where one partner is HIV-positive or can be very challenging. The importance of reproductive discussions for the care of women with HIV as well as involving both partners in discussions and providing information and education was identified as a priority in the care of those with HIV who are wishing to start a family.

Dr Mărdărescu also presented a UK-based case study ‘From pregnancy to baby and beyond’ as an example of a strategy that could be implemented in other countries to help support those who want to start a family, who are pregnant or who have already given birth. Based on a programme previously run in sub-Saharan Africa, the programme is based on training “Mentor Mothers” to offer peer support to women living with HIV to provide education, information and emotional support in all aspects of conception, antenatal and postnatal care. Please visit the Positively UK website for further information on ‘From pregnancy to baby and beyond’.

Other aspects of the care for women living with HIV, such as the management of complications during pregnancy and mother-to-child-transmission were also explored in this session.

For more information download the Women for Positive Action mini-lecture presentation.