Fertility concerns among people living with HIV: a systematic review and meta-synthesis.

This meta-synthesis systematically reviewed qualitative studies on fertility concerns among people living with HIV (PLWH) to inform targeted interventions. A systematic search of PubMed, Web of Science, CINAHL, Cochrane, and Embase was conducted from inception to October 15, 2025. Synthesizing 76 extracted themes from 18 studies revealed 11 subthemes organized into three overarching dimensions: biological (fear of transmission, health decline), psychological (shock, chronic distress, internalized stigma, reproductive ambivalence), and social (externalized stigma, economic constraints, policy/normative pressures, healthcare failures). Notable regional variations emerged, with fear of vertical transmission predominating in African studies, family pressure in Asian studies, and healthcare discrimination in the European study. The findings indicate that fertility concerns in PLWH arise from health anxiety, social discrimination, and inadequate support, leading to distress, relationship issues, and difficult reproductive choices. A comprehensive, multi-tiered intervention integrating medical, psychological, and social support is essential to alleviate these concerns, protect rights, and improve overall well-being.