Prevalence and correlates of having sexual and reproductive health priorities met by HIV providers among women living with HIV in a Canadian setting.

ABSTRACT

OBJECTIVE: To (1) describe the prevalence of key reproductive health outcomes (e.g., pregnancy, unintended pregnancy; abortion); and (2) examine social-structural correlates, including HIV stigma, of having key sexual and reproductive health (SRH) priorities met by participants' primary HIV provider, among women living with HIV. METHODS: Data were drawn from a longitudinal community-based open cohort (SHAWNA) of women living with HIV. The associations between social-structural factors and two outcomes representing having SRH priorities met by HIV providers ('being comfortable discussing sexual health [SH] and/or getting a Papanicolaou test' and 'being comfortable discussing reproductive health [RH] and/or pregnancy needs') were analyzed using bivariate and multivariable logistic regression models with generalized estimating equations for repeated measures over time. Adjusted odds ratios (AOR) and 95% confidence intervals [95% CIs] are reported. RESULTS: Of 314 participants, 77.1% reported having SH priorities met while 64.7% reported having RH priorities met by their primary HIV provider at baseline. In multivariable analysis, having SH priorities met was inversely associated with sexual minority identity (AOR 0.59, 95% CI 0.37-0.94), gender minority identity (AOR 0.52, 95% CI 0.29-0.95) and recent verbal or physical violence related to HIV status (AOR 0.55, 95% CI 0.31-0.97) and positively associated with recently accessing women-centred services (Oak Tree Clinic) (AOR 4.25, 95% CI 2.20-8.23). Having RH priorities met was inversely associated with sexual minority identity (AOR 0.56, 95% CI 0.40-0.79), gender minority identity (AOR 0.45, 95% CI 0.25-0.81) and being born in Canada (AOR 0.29, 95% CI 0.15-0.56) and positively associated with recently accessing women-centred services (AOR 1.81, 95% CI 1.29-2.53) and a history of pregnancy (AOR 2.25, 95% CI 1.47-3.44). CONCLUSION: Our findings suggest that there remain unmet priorities for safe SRH care and practice among women living with HIV, and in particular, for women living with HIV with sexual and/or gender minority identity and those who experience enacted HIV stigma. HIV providers should create safe, non-judgmental environments to facilitate discussions on SRH. These environments should be affirming of all sexual orientations and gender identities, culturally safe, culturally humble and use trauma-informed approaches.