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AIDS Patient Care STDS. 2017 Aug;31(8):348-355. doi: 10.1089/apc.2017.0098. Epub 2017 Jul 18.

Experiences Using Pre-Exposure Prophylaxis for Safer Conception Among HIV Serodiscordant Heterosexual Couples in the United States.

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1 Department of Community Health Sciences, Boston University School of Public Health , Boston, Massachusetts.
2 Department of Health Law, Policy & Management, Boston University School of Public Health , Boston, Massachusetts.
3 Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies , Tufts Medical Center, Boston, Massachusetts.
4 Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine , Boston, Massachusetts.
5 Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital , Bedford, Massachusetts.


Antiretroviral pre-exposure prophylaxis (PrEP) is a promising HIV prevention strategy for HIV serodiscordant couples (HIV-infected male, uninfected female) seeking safer conception. However, most research on PrEP for safer conception has focused on couples in sub-Saharan Africa; little is known about the perspectives or experiences of heterosexual couples in the United States. We conducted qualitative interviews with six couples (six women and five of their male partners) receiving PrEP for conception services at an urban safety net hospital in the US Northeast. In-depth interview guides explored couple relationships and contextual factors and attitudes, perceptions, and decision-making processes surrounding PrEP for safer conception. Thematic analyses focused on identifying the following emergent themes. We found that couple relationships were situated within broader social and cultural contexts of immigration, family, and community that shaped their experiences with HIV and serodiscordant relationship status. Despite strong partner support within relationships, HIV stigma and disapproval of serodiscordant relationships contributed to couples' feelings of social isolation and subsequent aspirations to have "normal" families. By enabling "natural" conception through condomless sex, PrEP for safer conception provided a sense of enhanced relationship intimacy. Couples called for increasing public awareness of PrEP through positive messaging as a way to combat HIV stigma. Findings suggest that relationship dynamics and broader social contexts appear to shape HIV serodiscordant couples' fertility desires and motivations to use PrEP. However, increased public awareness of PrEP for safer conception may be needed to combat HIV stigma at the community level.


HIV prevention; conception; fertility; heterosexual couples; pre-exposure prophylaxis; serodiscordant couples

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