HIV transmission behaviors, detectable HIV-RNA and curable STI prevalence among Ugandan men with HIV with reproductive goals, with and without infertility experiences

Many men with HIV (MWH) want children. MWH with unmet reproductive goals may prioritize conception over preventing HIV/STI transmission. Therefore, we evaluated whether MWH with unmet versus met reproductive goals were more likely to have detectable HIV-RNA or STIs, and explored socio-structural factors (e.g., HIV/infertility stigma, gender dynamics) conceptualized to influence this association. We recruited 100 MWH in Uganda who reported condomless sex with intent to conceive, half had/had not fathered a child in the last year, defined as ”met”/“unmet” reproductive goals. A questionnaire assessed demographics, sexual and health behaviors, infertility and childbearing stigmas, and socio-structural factors hypothesized to associate with the outcomes of prevalent detectable HIV-RNA or syphilis, gonorrhea, or chlamydia infection. We conducted logistic regression to assess whether unmet reproductive goals were associated with detectable HIV-RNA or STI. We enrolled 100 MWH: 50 had met, 50 had unmet reproductive goals. Median age was 41 (range 24-68). Most (89%) knew their pregnancy partner’s HIV serostatus, and 65% reported an HIV-negative partner. 10% had HIV-RNA > 200 copies/mL (“detectable”) and 30% had > 1 curable STI. Men reported stigma related to childbearing (4 (1.8-5.0), max 12) and infertility (63.5 (46.0-86.0), max 100). Unmet reproductive goals were not associated with detected HIV-RNA (aOR 0.79, 95%CI 0.14-4.57) or curable STI (aOR 1.02, 95%CI 0.39-2.65). Among MWH, unmet reproductive goals were not associated with HIV viremia or STIs. However, nearly one-third of MWH had curable STIs highlighting opportunities to improve STI screening and care for MWH to optimize the health of MWH, their partners and offspring.