Perceptions About the Relationship Between HIV, Antiretroviral Therapy (ART), and Fecundity in Sub-Saharan Africa: Findings from a Systematic Scoping Review

Advances in antiretroviral therapy (ART) enable women living with HIV to safely conceive and give birth without vertical transmission. However, in sub-Saharan Africa, 1 in 6 people experience infertility and women living with HIV face even higher rates. Research shows that ART and virologic suppression improve fertility/fecundity, yet this benefit is often overlooked in ART adherence education. To map the literature on people's understandings and beliefs about the relationship between HIV, ART, and fecundity, a systematic scoping review of the English and French literature in sub-Saharan Africa was conducted. After iterative search strategy development and implementation in PubMed, three independent reviewers screened texts, read a subset of full texts, and used a charting table to summarize results and identify emerging themes. Of 1,981 sources identified, only 12 met the inclusion criteria uncovering the following themes: (1) Beliefs that HIV and PrEP cause infertility exist but have not been widely documented; (2) Perceptions that ART improves health before pregnancy motivates women to adhere and provides hope about future pregnancy; (3) Stigma from providers discourage women living with HIV from seeking preconception care; and (4) Lack of awareness among providers and patients about the impact of HIV on pregnancy, highlights the need for provider training. Research on perceptions of HIV, ART, and fecundity in sub-Saharan Africa is sparse. Future research is needed to determine whether addressing this gap in understanding could improve ART adherence and help couples living with HIV build their families.