Providers need more training to counsel men living with HIV on family planning

Men are often left behind in efforts related to birth control, conception and pregnancy care, but involving them can have positive benefits. Men in relationships with women having conversations about pregnancy desires and reproductive health has been associated with increased contraception use, male partner HIV testing and condom use. Despite these known positive impacts, providers don’t consistently discuss family planning with couples affected by HIV.

Healthcare providers can play a critical role in male engagement in decision-making and help meet the needs of men, women and their families. New UCSF research looks at provider roles in talking to men living with HIV about family planning.

In a survey of health providers in San Francisco working with people living with HIV, researchers found that the majority of them believed that counseling on birth control and pregnancy desires was within their scope of practice. More than half of them reported including reproductive health counseling in their work, but there was considerable variation in which topics they discussed and how the discussion came up.

Providers were more likely to ask about birth control than desire for pregnancy when their male patients reported having sex with a female partner or already having a child. These are conversations that should be guided by the client’s preference rather than the provider’s discretion. They were also more likely to ask all of their male patients at least once about contraception than intention to start a family. This may reflect persistent stigma around pregnancy in couples affected by HIV, providers’ greater awareness of unintended pregnancy than fertility desires, or their comfort levels with the topics.

While many providers acknowledged the importance of discussions about intentions to start a family, previous research indicates that the discussions may be limited. Previous research has shown that patients may not always feel comfortable bringing up or participating in these conversations. Some perceived that providers made assumptions about their sex practices. That is reflected in survey respondents saying they didn’t ask patients about fertility intentions because they have sex with men, highlighting the need to educate providers about the pitfalls of these assumptions.

The survey also surfaced the importance of comprehensive counseling about safer conception. Twice as many providers reported discussing PrEP or sperm washing compared to timed intercourse as a way to conceive. These are interventions that require significant interaction with the healthcare system and may not meet everyone’s needs or desires.

Healthcare providers can play an important in supporting their patients’ reproductive goals and decreasing stigma around the desire to start families among couples affected by HIV. Key steps include nonjudgmental assessment of reproductive goals, providing information and options that are accurate and comprehensive and using patient-centered decision-making to guide treatment. More training and resources are needed to support providers in offering comprehensive, integrated sexual and reproductive health care for couples affected by HIV.