Routine reproductive counselling is essential for all women with HIV infection. ^[3] In a survey of 700 women with HIV infection in 2011, 22% of whom became pregnant after an HIV diagnosis, 58% had never discussed pregnancy or treatment options before pregnancy and 42% had limited or no knowledge of antiretroviral therapy (ART) options. ^[4]

Health providers seeing women with HIV infection should initiate a non-judgmental conversation with all women of child-bearing age concerning their reproductive desires. This process is ongoing and should be initiated in an appropriate timely manner shortly after initial HIV diagnosis.

Many women are aware of their HIV status before becoming pregnant and therefore issues that affect contraception and pregnancy can be addressed during their routine visits for HIV care. Of course, not all women with HIV infection will desire to become pregnant and they may have contraceptive needs that should be addressed. Some women with HIV infection may be reluctant to initiate this discussion. Health-care providers play an important role in optimising preconception health and supporting women to make informed reproductive decisions.

Preconception counselling and care should be offered to all women with HIV infection and ideally should:

• Be incorporated into routine health visits,
• Facilitate comprehensive family planning,
• Allow a woman’s reproductive wishes to be re-visited over time during her reproductive years, as relationships and circumstances may change,
• Provide education and counselling relating to contraception and pregnancy, targeted to the woman’s individual needs (does she want to achieve a pregnancy or avoid an unintended pregnancy),
• Allow ongoing identification of all potential risk factors for adverse maternal or foetal outcomes (e.g. increasing maternal age),
• Address all health issues and allow for the woman’s health to be optimised pre and post conception (Table 2).

Table 3. Preconception checklist