Knowledge and Acceptability of Safer Conception Methods among Couples on Antiretroviral Therapy and Antiretroviral Therapy Counselors of West Bengal

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Abstract Background: Antiretroviral therapy (ART) has reduced HIV-related mortality, enabling people living with HIV (PLHIV) to pursue parenthood. Advances in preventing mother-to-child transmission have further encouraged this desire. However, pregnancy increases HIV acquisition risks due to hormonal changes and behaviors like condomless sex. Safer conception methods, including ART, pre-exposure prophylaxis (PrEP), sperm washing, and voluntary medical male circumcision, are crucial for minimizing transmission. This study explores PLHIV’s attitudes and perceptions regarding safe conception practices, highlighting the need for accessible counseling services and ART counselors’ knowledge. Methodology: This qualitative study was conducted over 1 year in seven districts of West Bengal. Data were collected through in-depth interviews with ART counselors from seven ART centers and focus group discussions with 81 PLHIV couples. Thematic analysis using NVivo v12 was performed, with ethical approval and informed consent obtained. Results: Participants expressed concerns about their children’s future, such as discrimination and psychological issues. Most believed PLHIV couples should follow doctors’ advice to reduce HIV transmission risks during conception. Many found the semen cleansing method acceptable if available. pre-exposure prophylaxis (PrEP) was widely recommended by counselors and seen as critical for preventing transmission, even with semen cleansing. Conclusions: PLHIV couples are concerned about the lifelong treatment of children born through conception and childbirth. PrEP plays a key role in transmission prevention, and the semen cleansing method would be accepted if accessible.

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