Comparing fertility clinic care for individuals and couples living with and affected by HIV and in Canada from 2014 to 2023.

Abstract

Access to fertility care, particularly medically assisted conception (MAC), is a reproductive justice concern for individuals with HIV. This longitudinal study investigates MAC access for people with HIV in Canada. Surveys were distributed to medical and laboratory directors from 58 fertility clinics across nine provinces. Responses were initiated by 24/89 (27.0%) participants, representing 19/58 (32.8%) clinics in 7 provinces. Complete responses were received from 16/24 (66.7%) participants. Of the 14 clinics, 8 (57.1%) reported they will see individuals with HIV in consultation, with an additional 2 (10.5%) limiting this to people with an undetectable viral load. Respondents from 11 clinics, who completed the survey, answered questions about access to MAC. 9/11 (81.8%) offer intrauterine insemination if the viral load is undetectable, while 8/11 (62.5%) offer in vitro fertilization (IVF) under the same condition. Only one (9.1%) offers IVF regardless of viral load, 18.2% (2/11) do not offer IVF in the context of HIV. Three-quarters of the respondents were aware of Canadian guidelines related to HIV. Among those adopting guideline recommendations, 75% found them helpful. While the study's low response limits the generalizability, findings suggest that advocacy efforts are warranted to address reproductive rights for people with HIV, emphasizing U = U.