Providers caring for adolescents with perinatally-acquired HIV: Current practices and barriers to communication about sexual and reproductive health

Background: Adolescents with perinatally-acquired HIV (PHIV) engage in developmentally expected sexual behavior. Many have high fertility desires/intentions and low knowledge of mother-to-child transmission (MTCT). However, little is known about the content of discussions of sexual and reproductive (SRH) with their HIV healthcare providers (HHCPs). Methods: This cross-sectional study involved the completion of an online survey by medical (44.8%) and social service (55.2%) HHCPs (n=67) using snowball sampling. The survey elicited information regarding routine discussions about SRH and related barriers. Participants were mostly female (n=55), white (n=44), and had an average of 12.0 years of work experience. Results: The most frequently endorsed SRH topics discussed with both male and female patients were condom use (77.3%), STD prevention (73.1%), and screening (62.1%). Topics such as effects of STDs (21.2%) and HIV (7.6%) on fertility were infrequent. Approximately 30% of respondents discussed the risk of MTCT. Specific MTCT prevention strategies such as decreased viral load (16.7%) were less common. Females received significantly more education about SRH topics overall, though discussions about disclosure and condom use were similar for both sexes. The most frequently noted barriers to SRH communication included more pressing health concerns (53.0%), parent/guardian not receptive (43.9%), and personal reservations (37.9%). Conclusions: Providers discussed sexual health more frequently than fertility-related aspects of SRH. The provision of SRH education was disproportionately focused on females. Both sexes must receive holistic SRH-related information. Identifying barriers to SRH discussions in medical settings is crucial to support HIV transmission reduction efforts and maturing adolescents with PHIV.