DIS Research Assistantship: HIV and Fertility Treatment in Europe

Accessibility to Medically Assisted Reproduction for People Living with HIV in Europe

by Alice Pham

Background

As advances in treatment have made human immunodeficiency virus (HIV) a chronic and manageable disease, there is more attention toward increasing family planning options for people with HIV status (Martins et al., 2019). Some people living with HIV (PLWHIV) will be able to conceive without medical assistance, however, others may require safer conception to address underlying infertility, to further reduce the risks of partner-to-partner transmission, or to assist those not in a heterosexual relationship. An example of a safer conception is medically assisted reproduction or MAR, which includes sperm-washing with intrauterine insemination (IUI) and in vitro fertilization (IVF), or intracytoplasmic sperm injection (ICSI) (Barber et al., 2018).

There is limited access to fertility treatments, especially for PLWHIV. The lack of access to these resources is not only due to general disparities in access to fertility treatments, but also because PLWHIV often face stigma, financial, and policy barriers to accessing proper reproductive health care (Bell et al., 2019). There are additional cases where PLWHIV face barriers to MAR regardless of their HIV status, such as restrictions on access for single women and same-sex couples (Calhaz-Jorge et al., 2020). This mixed-method research investigates the availability and accessibility of medically assisted reproduction for people living with HIV in the WHO European Region.

DIS Program

DIS is a study abroad program that hosts students in Copenhagen and Stockholm. During the fall semester of 2021, I was a research assistant for the “HIV and Reproductive Technology Access” research assistantship through the DIS program in Copenhagen, Denmark. This research assistantship is one of many assistantships offered through the DIS program where students join an ongoing research project carried out by a DIS faculty member for academic credit (DIS, 2022). The “HIV and Reproductive Technology Access” research assistantship is led by Professor Rachel Irwin from Lund University. This project is for academic purposes that will add to existing health policy and systems research by examining the legal and policy frameworks which create barriers and opportunities for individuals seeking care.

HIV and Reproductive Technology Access Research Assistantship

With two other study abroad students, we policy mapped the availability and accessibility to HIV reproductive technology for PLWHIV across Europe. To do this qualitative research, each of us was assigned to a number of European countries which we then had to find and interview representatives of national HIV organizations, health professionals (embryologists, infectious disease and/or infertility specialists), European and national professional societies (fertility and/or infectious disease), or national regulatory authorities and individual clinics about policies regarding reproductive technology access for PLWHIV in their respective country. These interviews were completed via email correspondence or Zoom calls. By the end of the semester, we had data for a total of 14 countries (Andersen et al., 2022).

Fall 2021 Research Team (left to right): Colin Ford, Lily Silverman, Rachel Irwin, and Alice Pham

Table 1: Overview of Access

My assigned countries were Austria, Bosnia and Herzegovina, Czech Republic, Iceland, Kyrgyzstan, Lithuania, Monaco, North Macedonia, Moldova, San Marino, Slovenia, Turkey, and Uzbekistan. Out of these 13 countries, I only managed to hear sufficient information from Austria.

Based on my interviews with a gynecologist and a researcher in Austria, treatment is available for PLWHIV, except for single women due to their law in Austria, with a portion of the cost covered by the government. However, because PLWHIV is a small population, there is not enough urgency to have more of these fertility resources, so there are only a few clinics that can offer these services. This logistic challenge applies to other countries as well.

Treatment is offered to PLWHIV in 12 out of 14 countries mapped (Table 1), but patients still face logistical and financial barriers even in these 12 countries. It is fairly easier to find clinics that offer services in Belgium, Germany, Portugal, Spain, and the UK. However, services differ by city or region, and the full range of services is not always available to PLWHIV (Andersen et al., 2022).

The table on the left describes the general access to MAR for PLWHIV. To find more information about the results and research, click here.

Takeaways

This research has greatly expanded and globalized my perspectives on public health because this was the first time where I conducted research focused on Europe (even though the research question and applications of this research can be applied in the context of the US or other countries) and taught by faculty who came from a European background and education. This assistantship and study abroad experience has solidified my passion to continue public health research and exposed me to qualitative research. I want to continue doing research that will shed light on the adversities of vulnerable communities. This research has inspired me to pursue more global health research or opportunities abroad in the future as well.

A huge lesson for me was to learn how to present this research in a way that would not offend people living with HIV. PLWHIV has to face so much stigma, so my research team discussed ways to make sure that this research would not further stigmatize this group. Although I was interviewing experts who did not identify as a person living with HIV, I still had to be careful in how I worded and phrased my questions throughout the interviews. As much as it is important to conduct research that will uncover the need for PLWHIV, it is also equally important to acknowledge that this research is focused on a marginalized group of people who have to face stigma on a daily basis; they are not just data points.

References

Andersen, M. H., Alexander, M. T., Bintz, C., Ford, C., Mitchem, M., Pham, A., Silverman, L., & Irwin, R. (2022). Medically assisted reproduction for people living with HIV in Europe: A cross‐country exploratory policy comparison. HIV Medicine. https://doi.org/10.1111/hiv.13269
Barber, T. J., Borok, T., Suchak, T., Weatherall, A., Docherty, T., Gamble, N., Pralat, R., Jaspal, R., & Cocker, C. (2018). Having children outside a heterosexual relationship: Options for persons living with HIV. Sexually Transmitted Infections, 95(2), 99–101. https://doi.org/10.1136/sextrans-2018-053670
Bell, M., Edelstein, M., Hurwitz, S., & Irwin, R. (2019). Accessibility and availability of assistant reproductive technology for people living with HIV in Europe: A thematic literature review. AIDS Care, 32(8), 949–953. https://doi.org/10.1080/09540121.2019.1707471
Calhaz-Jorge, C., De Geyter, C. h, Kupka, M. S., Wyns, C., Mocanu, E., Motrenko, T., Scaravelli, G., Smeenk, J., Vidakovic, S., & Goossens, V. (2020). Survey on art and IUI: Legislation, regulation, funding and registries in European countries. Human Reproduction Open, 2020(1). https://doi.org/10.1093/hropen/hoz044
Martins, A., Alves, S., Chaves, C., Canavarro, M. C., & Pereira, M. (2019). Prevalence and factors associated with fertility desires/intentions among individuals in hiv‐serodiscordant relationships: A systematic review of empirical studies. Journal of the International AIDS Society, 22(5). https://doi.org/10.1002/jia2.25241
Undergraduate research at DIS Copenhagen. DIS Copenhagen Semester. (2022, February 14). Retrieved March 22, 2022, from https://disabroad.org/copenhagen/semester/enrich-academic-experience/undergraduate-research-dis/

Alice Pham

My name is Alice Pham and I am from Chicago, IL. I am a senior at Macalester College with a biology major, geography minor, and community and global health concentration. I am interested in learning about social determinants of health, health disparities, and learning ways to prevent them. Therefore, I want to go into public health as a career path particularly in the epidemiology field. I hope to do epidemiology research that will raise awareness on various public health issues. Outside of school, I like to bullet journal, make mini vlogs, and travel.

Image Credits:
Header Image: Creative Tail Sperm
DIS Logo: DIS Study Abroad in Scandinavia
Overview of Access Table: HIV Medicine Journal

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