Background Female positive/male negative (♀+/♂-) HIV-serodiscordant couples desiring children have expressed an interest in safer conception interventions to reduce HIV transmission. Approximately 45% of HIV-infected women desire children and may choose to engage in condomless sex to achieve pregnancy. Without routinely available preconception counselling and safer conception reproductive services, ♀+/♂- HIV-serodiscordant couples who desire children represent a key population at risk of sexual HIV transmission.

Methods We conducted a prospective study of ♀+/♂- HIV-serodiscordant couples desiring children in Kenya to evaluate the feasibility and efficacy of timed vaginal insemination (TVI). Eligible couples included female partners age 18–34 years with regular menses and HIV disclosure to male partners. Prior to TVI, couples were tested and treated for STIs, advised on and monitored for consistent condom use (i.e. evaluation for the presence of prostate specific antigen) and regular menses, and educated on TVI. The intervention included sexual intercourse with a condom and semen collection with a syringe for TVI during the fertile window for up to six menstrual cycles. Time to pregnancy with TVI was assessed with a Kaplan-Meier analysis.

Results Forty ♀+/♂- HIV-serodiscordant couples were enrolled. Seventeen couples exited prior to TVI due to dissolution of the relationship (n = 4), voluntary cessation of study participation (n = 2), HIV seroconversion (n = 2), irregular menses (n = 2), or lost to follow-up (n = 7). Twenty-three couples (57.5%) were introduced to TVI. At baseline, 17 (73.9%) women reported ease with the TVI procedures. We observed eight pregnancies without HIV transmission, which resulted in six live births and two non-viable infants. Accounting for loss to follow-up, we estimate that 36% of women will become pregnant within 150 days of TVI initiation.

Conclusion Given the desire for children amongst HIV-affected couples, TVI may be acceptable and as effective in achieving pregnancy as natural conception while minimising the risk of HIV transmission.

Disclosure of interest statement This research was supported by a grant from the National Institutes of Health (NIH), University of California San Francisco-Gladstone Institute of Virology and Immunology Centre for AIDS Research (P30 AI027763).  O. Mmeje was partly supported by NIH/T32–5T32AI065388–03.