O-13: Reproductive Health Options among HIV-Infected Persons in The Low Income Niger Delta of Nigeria

Background: With the advent and wide spread use of Highly Active Antiretroviral Therapy (HAART) for the treatment of HIV, persons living with HIV/AIDS are living a good quality, longer and healthier lives. Many HIVaffected couples (sero-discordant and sero-concordant) are beginning to consider options for safer reproduction. The aim of this study was to assess the reproductive health concerns among persons living with HIV/AIDS in the Niger Delta of Nigeria. Materials and Methods: The reproductive health options was investigated among 195 HIV-infected subjects who were aged 18 - 58 years, mean age of 41.25 ± 11.50 years and made up of 88 males (45.1%) and 107 females (54.9). Results: Out of the 195 subjects studied, 111 (56.9 %) indicated their desire to have children. The main reasons for wanting to procreate included: ensuring lineage continuity and posterity (52.3%), securing relationships (27.0%) and pressure from relatives to reproduce (20.7%). Single subjects were more inclined to have children (76.3%) compared to married (51.5%), widowed (18.2%) and separated/divorced (11.1%) (p=0.03). Of the 111 subjects that indicated their desire to have children, women were more inclined to have children (64.5%) compared to men (47.7%). The major concern among the 84 (43.1%) subjects not desiring more children were the fear of infecting sero-discordant partner and baby (57.1%), fear of dying and leaving behind orphans (28.6%) and the fear that they may become too ill and unable to financially support the child (14.3%). Persons with no formal education were more likely to have children irrespective of their positive HIV status (66.7%) compared to persons educated to tertiary education level (37.0%) (p=0.01) as can be seen in table 1. Out of the 111 subjects that desired to have more children, only 58% had gone for reproductive health counseling with HIV counselors. Reasons for not seeking advice were anticipated negative reactions and discrimination from the counselors. A significant number of subjects were only aware of some reproductive health options available to reduce risk of infecting their partners and or baby such as artificial vaginal insemination, intrauterine insemination, caesarean section, avoidance of breast feeding and offering prenatal pre-exposure prophylaxis to the fetus. They were unaware of other options such as sperm washing, IVF and ICSI. Of the 43.1% not anticipating more children, 36.9% were anticipating adoption. Conclusion: Our study has shown that a significant number of HIV-infected in the Niger Delta of Nigeria desire to have more children irrespective of their positive sero status. There is the need to support the sexual and reproductive rights of HIV-infected individuals. Additional training needs to be offered to HIV counselors on evidence- based best and affordable practices regarding reproductive health issues among persons living with HIV. Policies that support the availability and accessibility to relevant reproductive and sexual health services including contraception and procreation needs to be developed. Public enlightenment programs on HIV are needed to reduce the stigmatization that HIV-infected persons face from family members and their communities.