Willingness to use HIV prevention strategies to conceive with an HIV-positive partner: opinions from HIV-negative women in serodifferent relationships Joelle Brown, MPH PhD (1,2), Shannon Weber, MSW (3), Erika Aaron, CRNP (4), Nena Barnhart (5), Deborah Cohan, MD MPH (2) (1) University of California, San Francisco, Departments of Epidemiology and Biostatistics, (2) Obstetrics, Gynecology, and Reproductive Sciences, and (3) Family and Community Medicine, (4) Drexel University College of Medicine, Division of Infectious Diseases and HIV Medicine, (5) Kaiser Permanente For more information: Contact: Shannon Weber Joelle Brown Introduction HIV-positive women and men are living long and productive lives in the United States. An estimated 140,000 serodifferent heterosexual couples are in the US, half of whom want to have children. Many HIV-negative women with HIV-positive male partners would like to become parents but little is known about their willingness to use interventions to reduce HIV transmission risk. We conducted an online survey of HIV-negative women with HIV-positive partners to evaluate the acceptability of and willingness to use various HIV prevention strategies in order to conceive. Methods Anonymous web-based, cross-sectional survey among HIV-negative women in serodifferent relationships and who wanted to parent now or in the future Surveys completed between February 2010 and December 2014 Patients recruited through their providers based at HIV specialty clinics, fertility clinics, and through HIV- related websites and media coverage Women referred to a weblink that could be accessed from a personal computer and completed a self- administered, computer-based, confidential survey Results 98 HIV-negative women with HIV-positive male partners Average age was 32 years (IQR 27-36; range 19-48) Two-thirds (64%) Caucasian, 26% African American, 7% Latina Nearly all (98%) had a high school education Participants came from 19 states across the United States: Acknowledgements/Funding Macy’s Foundation, National Institutes of Mental Health (NIH/NIMH K01MH100994) Photo credit: Ryan Anson HIV- negative woman with HIV-positive male partner 63% Sperm washing with Intrauterine insemination 46% Pre- exposure Prophylaxis (PrEP) 43% Adoption 42% Condomless sex timed to peak fertility 41% In-vitro fertilization (with sperm washing) 40% Post- exposure prophylaxis (PEP) 9% Sperm donation 1. Nearly all (97%) women reported wanting to have a child now or in the future with their current HIV-positive partner. 2. All women expressed willingness to use at least one method to reduce the chance of HIV transmission while trying to conceive: Figure 2. Percent of women reporting they would use this method to reduce the chance of HIV transmission while trying to conceive Figure 1. Percent of participants residing in four regions of the United States 3. Women estimated their risk of HIV acquisition was between <1% to 100% while trying to get pregnant with an HIV-positive man (median 30%, IQR 5%-50%). 4. All women said they would accept some risk of HIV acquisition while trying to conceive with their current partner: Summary/Conclusions Women willingly accept a level of risk to conceive a child with their HIV-positive male partners All women in this study were willing to use safer conception services in order to achieve pregnancy and lower their risk for HIV Safer conception services need to be accessible and affordable in order to meet this need Safer conception services are an important part of reproductive health and critical to the larger public health goals of eliminating sexual and perinatal transmission of HIV Figure 3. Level of HIV risk women are willing to accept in order to conceive with an HIV-positive man