Commentary argues for stronger family planning support for people with HIV

A new commentary co-authored by obstetricians across four provinces is encouraging pregnancy care providers to lean on Canada's evidence-based guidelines to support prospective parents living with and affected by HIV.

The commentary, published Monday in alignment with World AIDS Day, comes as people with HIV are living longer, healthier lives and, in many cases, having children. Yet, the authors argue, they often face unequal access to quality, evidence-based pregnancy planning and support.

In offering pregnancy planning counseling to patients with HIV, clinicians should use the Canadian HIV Pregnancy Planning Guidelines, updated in 2018. However, the authors recognize the guidelines can be "daunting and cumbersome." The commentary, published in the Journal of Obstetrics and Gynaecology Canada, addresses this by offering simple, clearly-written steps doctors can use to help provide quality care to their patients—and honor their reproductive rights.

"By writing this concise, practice-based commentary we hope that pregnancy care providers will see that offering pre-conception counseling for people living with and affected by HIV is very feasible," said Dr. Mark Yudin, obstetrician at St. Michael's Hospital and co-author of the commentary.

The commentary is framed around five key considerations for pregnancy care providers in providing pregnancy planning counseling to people living with and affected by HIV:

1. When a person living with HIV has an undetectable viral load, they cannot transmit the virus to sexual partners.
2. Condomless sex is safe and recommended for conception for couples living with and affected by HIV when the partner living with HIV has an undetectable viral load.
3. Access to comprehensive assisted reproductive technology remains a priority for people living with HIV.
4. Initiating antiretroviral therapy prior to conception is now recommended.
5. Pregnancy planning care should also include discussing contraception.

The authors say pregnancy care providers across Canada may feel better positioned to offer pregnancy planning counseling to those affected by HIV with an awareness of these key considerations. They also say providing this support is a matter of honoring patients' rights.

"Access to pregnancy planning support is an issue of reproductive rights for people living with HIV," said Logan Kennedy, a Registered Nurse and Research Associate at Women's College Hospital and co-author of the commentary.

"There continues to be disparity in access to comprehensive, evidence-based pregnancy planning support for people living with and affected by HIV across Canada. We are fortunate in Canada to have comprehensive, evidence-based guidelines to support clinicians in offering pregnancy planning counseling."