The double burden of HIV and infertility in Rwanda: what lessons can we learn for infertility care in sub-Saharan Africa?

Introduction: When planning infertility services in sub-Saharan Africa (SSA) the management of HIV infected couples needs careful attention. Very little is known about the potential demand for infertility services among HIV infected couples, the interplay between HIV infection and infertility and the specific counselling needs of this group. Methods: A review of the literature was combined with data from own field research, a case-controlled study in an infertility clinic in the Kigali University Teaching Hospital in Rwanda. Results and discussion: Based on the limited available evidence it can be hypothesized that in SSA a substantial number of HIV infected couples suffer from decreased fertility but no firm conclusions can be drawn on the actual prevalence of infertility in HIV infected couples, or their potential demand for fertility services. The interaction between HIV and fertility desires is complex and varies considerably between individuals. The severe psychosocial problems HIV infected infertile couples face and the ethical dilemma between the right or desire to reproduce and the risk or fear of transmitting the virus adds considerably to the complexity of the infertility care of these patients. Conclusion: The management of patients, carrying the double burden of HIV and infertility is challenging from an ethical, psychological and medical point of view and requires specific counselling skills.