Saleem Haneefa T, Narasimhan Manjulaa, Denison Julie A, Kennedy Caitlin E
Center for Global Health Engagement, Uniformed Services University of the Health Sciences, Rockville, MD, USA.
Department of Reproductive Health Research, (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme - HRP), World Health Organization, Geneva, Switzerland.
J Int AIDS Soc. 2017 Mar 8;20(Suppl 1):21331. doi: 10.7448/IAS.20.2.21331.
The recognition and fulfilment of the sexual and reproductive health and rights (SRHR) of all individuals and couples affected by HIV, including HIV-serodiscordant couples, requires intervention strategies aimed at achieving safe and healthy pregnancies and preventing undesired pregnancies. Reducing risk of horizontal and vertical transmission and addressing HIV-related infertility are key components of such interventions. In this commentary, we present challenges and opportunities for achieving safe pregnancies for serodiscordant couples through a social ecological lens. At the individual level, knowledge (e.g. of HIV status, assisted reproductive technologies) and skills (e.g. adhering to antiretroviral therapy or pre-exposure prophylaxis) are important. At the couple level, communication between partners around HIV status disclosure, fertility desires and safer pregnancy is required. Within the structural domain, social norms, stigma and discrimination from families, community and social networks influence individual and couple experiences. The availability and quality of safer conception and fertility support services within the healthcare system remains essential, including training for healthcare providers and strengthening integration of SRHR and HIV services. Policies, legislation and funding can improve access to SRHR services. A social ecological framework allows us to examine interactions between levels and how interventions at multiple levels can better support HIV-serodiscordant couples to achieve safe pregnancies. Strategies to achieve safer pregnancies should consider interrelated challenges at different levels of a social ecological framework. Interventions across multiple levels, implemented concurrently, have the potential to maximize impact and ensure the full SRHR of HIV-serodiscordant couples.
认识并实现所有受艾滋病毒影响的个人和伴侣（包括血清学不一致的伴侣）的性健康和生殖健康及权利，需要采取干预策略，以实现安全健康的怀孕并预防意外怀孕。降低水平传播和垂直传播的风险以及解决与艾滋病毒相关的不孕症是此类干预措施的关键组成部分。在这篇评论中，我们从社会生态视角探讨血清学不一致的伴侣实现安全怀孕所面临的挑战和机遇。在个人层面，知识（如艾滋病毒感染状况、辅助生殖技术）和技能（如坚持抗逆转录病毒治疗或暴露前预防）很重要。在伴侣层面，伴侣之间需要就艾滋病毒感染状况的披露、生育意愿和更安全的怀孕进行沟通。在结构领域，家庭、社区和社会网络的社会规范、耻辱感和歧视会影响个人和伴侣的经历。医疗保健系统中更安全的受孕和生育支持服务的可及性和质量仍然至关重要，包括对医疗保健提供者的培训以及加强性健康和生殖健康及权利与艾滋病毒服务的整合。政策、立法和资金可以改善获得性健康和生殖健康及权利服务的机会。社会生态框架使我们能够审视不同层面之间的相互作用，以及多层次干预如何能更好地支持血清学不一致的伴侣实现安全怀孕。实现更安全怀孕的策略应考虑社会生态框架不同层面的相互关联的挑战。同时实施多层次的干预措施有可能最大限度地扩大影响，并确保血清学不一致的伴侣充分享有性健康和生殖健康及权利。
