1. Reproductive Choices and Decisions for Clients with HIV pregnancy childbearing contraception

2. Pregnancy in Women with HIV Positive developments: ARV therapy improves health/longevity PMTCT reduces vertical transmission Wider availability of support and care services Does not accelerate disease One-third pass HIV to newborn during pregnancy, delivery, and breastfeeding Possible increased risk of stillbirth and low birth weight Source: Saada, 2000; Tai, 2007; Brocklehurst, 1998.

3. Reasons Clients with HIV May Consider Pregnancy Intense desire to have children Pressure to have children Fear that older children may die Concern about infertility Reassured by PMTCT Optimism about ARV therapy Avoid generating suspicions Apprehension about disclosing status Source: Preble, 2003.

4. Reasons Clients with HIV May Avoid Childbearing Similar concerns to women without HIV: –economic status –desired family size –ideal spacing Concerns about health and quality of life Fear of transmitting HIV Anxiety about leaving orphans Concerns about limited access to help

5. In Their Own Words … I would be committing a great sin if I would have another child knowing this one is sick. I would be putting responsibility on other people and killing myself. – Woman on ART People who are unable to have children find it difficult to lead happy lives. – Man on ART When I am married I will have to have a baby because only I and my boyfriend are aware that I am HIV-positive and people will ask why am I not becoming pregnant in marriage. – Woman with HIV The community questions a woman falling pregnant while she knew her HIV status. – Woman with HIV

6. Access to Information/Services is Key Consider reproductive choices Plan for the future Avoid unintended pregnancy Time pregnancy when health is optimal Reduce HIV transmission to children Reduce transmission to partners Source: Chen, 2001.

7. Many Women with HIV Want to Use FP Source: King, 1995. Pregnancy rate among women with HIV in Rwandan study 22% 9% During this period, contraceptive use increased from 16% to 24%.

8. Choices for Clients with HIV 1.Fertility decision: desire pregnancy?Pregnancy desired No Yes 2.Informed decision(s): contraceptive method? STI/HIV prevention? Intended pregnancy Pregnancy counseling Contraceptive counseling Ongoing HIV counseling Safe/effective contraception 3.Treatment decision(s): ARV therapy for self and partner? PMTCT? PMTCT services No Yes ARV treatment No Yes Adapted from: Cates, 2001.