Predictors of Safer Conception Practices Among HIV-Infected Women in Northern Nigeria

Background: Persons living with HIV often face discrimination in safe sex and reproductive choices, especially in low-resource settings. This study assessed fertility desires and intentions, risk perception and correlates of ever use of at least one safer conception method among HIV-infected women attending a tertiary health facility in Kano, Nigeria. Methods: Structured questionnaires were administered to a cross section of 328 of 427 eligible HIV-infected women. Fertility desires and intentions, risk perception and safer conception practice were analyzed. Logistic regression was employed to assess for predictors. Results: Of the 328 respondents, 150 respondents (45.7%) wanted more children. The proportions of respondents aware of their transmission risk during pregnancy, delivery, and breastfeeding were 69.5%, 75.3%, and 78.9%, respectively. Further, 68.9% of respondents were aware of the prospects of bearing HIV-negative children without infecting their partners. About 64.8% of women were aware of at least one safer conception method. Safer conception methods ever-used by the participants include: antiretroviral therapy (ART) (36.7%), timed unprotected intercourse with (10.9%), and without pre-exposure prophylaxis (PrEP) (17.2%), intravaginal insemination (7.3%) and intrauterine insemination (4.7%). Safer conception practice was predicted by marital status (married versus single, adjusted odds ratio [AOR] = 1.50, 95% CI = 1.10-3.55), parity (2-4 versus 0, AOR = 12.1, 95% CI = 3.7-39.8), occupation (civil servants versus traders, AOR = 0.37, 95% CI = 0.16-0.86), husband’s serostatus (seroconcordant versus serodiscordant) (AOR = 1.51, 95% CI = 1.13-4.64), couple contraceptive use (users versus non-users) (AOR = 1.62, 95% CI = 1.16-5.83) and transmission risk perception (high risk versus low/no risk) (AOR = 2.14, 95% CI = 1.18-3.90). Conclusion: We found high levels of fertility desires and intentions and moderate risk perception among a cohort of HIV-infected women in urban Kano, Nigeria. The use of safer conception practices was not common. Our findings underscore the need for healthcare provider capacity building to enhance safer conception counseling and service delivery.