1. #AIDS2016 | @AIDS_conference Pregnancy Intentions and Safer Pregnancy Knowledge Among Female Sex Workers in Port Elizabeth, South Africa Authors: Rao, A. 1 ; Baral S. 1 ; Phaswana-Mafuya, N. 2 ; Lambert, A. 3 ; Kose, Z. 2 ; Mcingana, M. 3 ; Holland, C. 1 ; Ketende, S. 1 ; Schwartz, S. 1 1 Johns Hopkins Bloomberg School of Public Health; 2 Human Sciences Research Council; 3 TB/HIV Care Association

2. #AIDS2016 | @AIDS_conference GENERAL POPULATION 18% WOMEN 16-18% WOMEN OF REPRODUTIVE AGE 23% FEMALE SEX WORKERS 60% Disproportionate Burden of HIV

3. #AIDS2016 | @AIDS_conference FSW and pregnancy experience  The same factors that put female sex workers (FSW) at greater risk for HIV acquisition also increase the likelihood of pregnancy  Increased sexual acts  Barriers to condom use  But many pregnancies are intended, and FSW may have different reproductive goals with different partners

4. #AIDS2016 | @AIDS_conference Safer Conception  South African guidelines for safer conception  Ensure that conception and pregnancy occur with minimal horizontal and vertical transmission risks  Identifying pregnancy intentions and providing guidance may be especially important among FSW  Disproportionate HIV burden  Structural barriers to health care

5. #AIDS2016 | @AIDS_conference Objectives  To assess if there was any association between knowledge of HIV status and desire to have children among FSW in Port Elizabeth  To establish level of knowledge of different methods of safer conception and to assess any association between knowledge of methods and HIV status among FSW in Port Elizabeth FERTILITY INTENTIONS SAFER CONCEPTION KNOWLEDGE

6. #AIDS2016 | @AIDS_conference Methods  Secondary analysis of a cross-sectional respondent-driven sampling study designed to assess HIV prevalence and vertical transmission in FSW  FERTILITY INTENTIONS  Poisson regression with robust variance estimation was used to assess both crude and adjusted association of knowledge of HIV status with future pregnancy intentions  SAFER CONCEPTION KNOWLEDGE  Knowledge of methods for safer conception were compared by awareness of HIV status using Fisher exact tests for proportions  ARV-based: ART for the infected partner; PrEP for the uninfected partner; ART during pregnancy  Non-ARV-based: Timed intercourse; Self-insemination; Sperm washing; Sperm donors

7. #AIDS2016 | @AIDS_conference Demographic characteristics Overall n=391 HIV- n=142 HIV+ no prior dx n=46 HIV+ prior dx n=203 p-value Age, years 18-24 25-34 35+ 122 (31.2) 204 (52.2) 65 (16.6) 69 (48.6) 54 (38.0) 19 (13.4) 16 (34.8) 24 (52.2) 6 (13.0) 37 (18.2) 126 (62.1) 40 (19.7) <0.001 Education completed Primary or less Some secondary Secondary or more 45 (11.5) 287 (73.4) 59 (15.1) 16 (11.3) 96 (67.6) 30 (21.1) 5 (10.9) 37 (80.4) 4 (8.7) 24 (11.8) 154 (75.9) 25 (12.3) 0.162 Race Black Mixed race White or Indian 320 (82.9) 60 (15.5) 6 (1.6) 96 (69.1) 37 (26.6) 6 (4.3) 37 (80.4) 9 (19.6) 0 (0.0) 187 (93.0) 14 (6.9) 0 (0.0) <0.001 Number of living children None One Two or more 99 (25.3) 126 (32.2) 166 (42.5) 48 (33.8) 41 (28.9) 53 (37.3) 13 (28.3) 15 (32.6) 18 (39.1) 38 (18.7) 70 (34.5) 95 (46.8) 0.034 Contraceptive method No contraception Male condom Birth control pill Implant Injectable Intrauterine device Female sterilization 54 (13.8) 126 (32.2) 6 (1.5) 23 (5.9) 161 (41.2) 6 (1.5) 16 (3.8) 19 (13.4) 52 (36.6) 2 (1.4) 8 (5.6) 53 (37.3) 4 (2.8) 8 (17.4) 22 (47.8) 0 (0.0) 3 (6.5) 12 (26.1) 0 (0.0) 1 (2.2) 27 (13.3) 52 (25.6) 4 (2.0) 12 (5.9) 96 (47.3) 2 (1.0) 10 (4.9) 0.133

8. #AIDS2016 | @AIDS_conference Crude prevalence ratios (log scale) of pregnancy intentions FSW in Port Elizabeth (n=379) 48.2% of women expressed current or future pregnancy intentions FERTILITY INTENTIONS

9. #AIDS2016 | @AIDS_conference Adjusted prevalence ratios (log scale) of pregnancy intentions FSW in Port Elizabeth (n=379) FERTILITY INTENTIONS

10. #AIDS2016 | @AIDS_conference Knowledge of HIV transmission prevention strategies for safe conception SAFER CONCEPTION KNOWLEDGE

11. #AIDS2016 | @AIDS_conference Knowledge of HIV transmission prevention strategies for safe conception SAFER CONCEPTION KNOWLEDGE

12. #AIDS2016 | @AIDS_conference Knowledge of HIV transmission prevention strategies for safe conception SAFER CONCEPTION KNOWLEDGE

13. #AIDS2016 | @AIDS_conference Conclusions  Pregnancy intentions did not significantly differ according to HIV status  Fertility intentions were high, but knowledge of safer conception methods was low  There exists a real need to provide FSW with advice around options to conceive safely, especially in the context of high HIV prevalence

14. #AIDS2016 | @AIDS_conference Acknowledgements Thank you to the research team at the Human Sciences Research Council (HSRC) for welcoming me into your offices and giving me useful input as this project progressed. Thank you as well to the outreach team at TB/HIV Care Association (THCA), without whom the implementation of this study would not have been possible. Thank you to everyone at the Center for Public Health and Human Rights for providing me with much needed support and guidance. A very special thank you to all the women who participated in this study and took the time to provide us with this valuable information.