Fertility counseling experiences and perceived gaps in provider support among people living with HIV: a qualitative study from an antiretroviral therapy clinic in Ghana.

Introduction: Antiretroviral therapy (ART) has made safer childbearing achievable for people living with HIV (PLHIV), and the reproductive health counseling PLHIV receive within HIV care shapes whether they can act safely on their fertility intentions. This study explored, from the perspective of PLHIV themselves, how the reproductive counseling they reported receiving shaped their fertility decision making, and which aspects of counseling support they perceived to be missing. Methods: A qualitative descriptive design with inductive reflexive thematic analysis was used. Twelve PLHIV (nine women, three men) distributed across the 26-50 year age bands and receiving ART at St. Michael's Hospital ART clinic, Pramso, Ashanti Region, were recruited through maximum variation purposive sampling within criterion based eligibility. In depth semi structured interviews were conducted between August and October 2024, audio recorded, transcribed verbatim, and coded by both authors, with differences resolved by consensus. Reporting followed the Consolidated Criteria for Reporting Qualitative Research. Results: Three themes were developed. First, participants reported clear and reassuring education on prevention of vertical (mother to child) transmission, while describing little guidance on conceiving safely with a partner of a different HIV status. Second, participants described providers as warm and accessible, yet experienced the counseling itself as general rather than matched to their own circumstances. Third, participants reported reliable treatment access and routine reproductive education, but described few services beyond education and basic counseling. Discussion: Participants perceived gaps in counseling support, particularly beyond prevention of vertical transmission. These are reported experiences and do not measure counseling quality or provider knowledge, and they may equally reflect consultation time, service organization, referral availability, and the faith based institutional context. The findings indicate areas that participants themselves identified for strengthening, including safer conception counseling, individualized fertility planning, and clearer referral pathways.