Skye McGregor

This session coverage topics related to sexual and reproductive health in Kenya, Thailand, and sub-Saharan Africa, eastern Europe and Central Asia. Topics covered the impact of in utero PrEP use, HIV self-testing and PrEP acceptance among pregnant women, and drug-drug interactions between feminizing hormones and PrEP, and reproductive coercion.

Data were presented from the parent study (Wu) in Kenya, to show no association between in utero PrEP use (self-report) and height and bone mineral density in infants, at 36 months. Children were randomly selected and matched 1:2 with infants with no in utero PrEP use. Ngumbau presented data from the PrIMA trial in Kenya, to examine cofactors of HIV self-testing and PrEP use among pregnant women at high risk of HIV. HIV self-testing was more acceptable than PrEP (69% vs 18%), HIV self-testing increased awareness of partners HIV status from 4.7% to 82.0%. Co-factors influenced the choice of prevention. The iFACT3 study in Thailand (Akarin) examined drug-drug interactions among transgender women (FHT and PrEP) showing no clinically significant difference in concentration of drugs, providing further evidence of confidence in the use of F/TAF-based oral daily PrEP. The people living with HIV Stigma Index 2.0 study (Lyons) demonstrated a significant impact of reproductive coercion in women living with HIV, across Eastern Europe and Central Asia, and Sub-Saharan Africa, including forced sterilization, coercion of contraception and family planning and coercion of pregnancy and feeding. Sex workers, migrants, women who inject drugs, and young women had greater odds of reproductive coercion.

All the sessions had a strong focus on equity and justice, and the right of people to make reproductive and HIV prevention choices. Future in utero PrEP studies would be strengthened by accurately quantifying PrEP use vs. self-report. HIV prevention programs (HIV self-testing and PrEP) need to empower pregnant women to enable HIV prevention choices. While transgender women shouldn’t have to choose between FHT and PrEP use, further work is needed to support changes to guidelines. There is an urgent need to address reproductive coercion, and combining quantitative and qualitative data may address outstanding research questions in this area.