Reproductive health decision-making in perinatally HIV-infected adolescents and young adults

Abstract

With widespread access to antiretroviral therapy in the United States, many perinatally HIV-infected (PHIV+) children are surviving into adolescence and adulthood, becoming sexually active and making decisions about their reproductive health. The literature focusing on the reproductive decisions of individuals behaviorally infected with HIV can serve as a springboard for understanding the decision-making process of PHIV+ youth. Yet, there are many differences that critically distinguish reproductive health and related decision-making of PHIV+ youth. Given the potential public health implications of their reproductive decisions, better understanding of factors influencing the decision-making process is needed to help inform the development of salient treatment and prevention interventions. To begin addressing this understudied area, a "think tank" session, comprised of clinicians, medical providers, and researchers with expertise in the area of adolescent HIV, was held in Bethesda, MD, on September 21, 2011. The focus was to explore what is known about factors that influence the reproductive decision-making of PHIV+ adolescents and young adults, determine what important data are needed in order to develop appropriate intervention for PHIV+ youth having children, and to recommend future directions for the field in terms of designing and carrying out collaborative studies. In this report, we summarize the findings from this meeting. The paper is organized around the key themes that emerged, including utilizing a developmental perspective to create an operational definition of reproductive decision-making, integration of psychosocial services with medical management, and how to design future research studies. Case examples are presented and model program components proposed.

Fig. 1

Panel-proposed developmental objectives and goals. The developmental view, illustrated in this picture, places reproductive health decision-making of PHIV₊ youth on the continuum which includes other age- and development-dependent bio-psycho-social milestones. In this view, although reproductive health naturally comes into focus during adolescence and (young) adulthood, the stage for it is being set from birth. The panel strongly endorsed this view as the framework for formulating research objectives and potential future clinical approaches designed to optimize reproductive decision-making and reproductive health outcomes among PHIV₊ individuals. PHIV₊ perinatally HIV-infected, RDM reproductive decision-making