23 – Sexual, Reproductive, and Pregnancy Health Among People With Perinatal HIV

Since 1990 an estimated 11 million children have been born with HIV and with the successful global role out of paediatric antiretroviral therapy (ART) increasing numbers of young people are transitioning through adolescence and entering adult care. In resourced settings with earlier access to ART the oldest survivors are now entering their 5th decade of life but with a legacy of years of unsuppressed viraemia and/or exposure to older more toxic ART agents. However survivor bias means they represent a unique cohort who survived childhood without access to ART, with slower disease progression and likely favourable host genetics and immune responses. In contrast many of those born in more recent decades started ART in early childhood and are more likely reflective of the emerging adolescent perinatal cohorts globally, important in identifying the consequences of lifelong HIV and ART exposure throughout postnatal, childhood and adolescent development in the ART era. This talk will follow the journey of a young person living with perinatal HIV through the unique challenges of adolescence, a period of life encompassing complex biological and psychosocial changes that include sexual maturation, development of sexual identity and the onset of sexual activity, through to pregnancy and parenthood. We will examine existing data on sexual and reproductive health for this unique cohort, born into a family living with HIV and the challenges of negotiating adolescence with a potentially sexually transmissible infection for the first and every subsequent sexual encounter and that sharing your status potentially discloses the status of other family members. We will focus on biomedical prevention strategies including sexual health education, vaccination, contraception and screening for sexually transmitted infections and for anogenital cancers. Increasing numbers of young people born with HIV are choosing to start families with pregnancy data emerging, including the early infant outcomes for a unique cohort of “3rd Generation” HIV exposed uninfected infants born to people who themselves have lived with HIV their entire lives. Finally we will identify data gaps in sexual, reproductive and pregnancy health for this cohort, highlighting future research questions and the importance of the meaningful inclusion of youth in setting the research agenda to support them in fulfilling their potential as adults, partners and parents.