Reproductive health among women living with HIV attending Melbourne Sexual Health Centre for HIV care from February 2019 to February 2020.

Background: Women living with HIV are a minority population with unique care needs. Rates of unintended pregnancy are higher among women living with HIV versus HIV negative women. However, uptake of contraception among women living with HIV including long-acting-reversible contraceptives (LARCs) remains low. This quality improvement project aimed to identify gaps in reproductive healthcare for women living with HIV attending Melbourne Sexual Health Centre (MSHC). Methods: We performed a retrospective review of women living with HIV attending MSHC for HIV care February 2019–February 2020. Women aged over 45 years were excluded. Primary outcomes included proportion using contraception, methods used and whether a sexual or reproductive health history had been taken in the past year. Results: A total of 100 women were included, predominantly born overseas (Asia, 38%; sub-Saharan Africa, 34%). Of these, 5% were pregnant, 16% were trying to conceive and 1% were undergoing elective oocyte preservation. Of the remaining 74 women, 48.6% were using any form of contraception, including 17.6% women using less-effective methods (withdrawal and condoms), 6.8% using the combined oral contraceptive pill, 18.9% using LARCs and 5.4% using permanent methods. Sexual activity status was documented for 61% women, 1% declined to answer and not documented for 38% women. Conclusions: Rate of contraceptive use in this study was lower than previously reported among women living with HIV in Australia; however, our findings suggest contraceptive methods may be changing in light of undetectable equals untransmittable and increased fertility desires. Discussions regarding sexual activity and reproductive health were limited. Mechanisms to increase clinician–patient discourse regarding these important issues should be explored. Women living with HIV are a minority in Australia. They present unique healthcare challenges, particularly relating to sexual and reproductive health. Evidence shows higher rates of unplanned pregnancy and lower rates of long-acting-reversible contraception use among women living with HIV. We highlight gaps in care at an Australian metropolitan centre and suggest contraceptive options used by women living with HIV may be changing in the era of modern HIV treatment. We suggest changes in care provision to meet demand, including use of 'women-centred' models of care. [ABSTRACT FROM AUTHOR]