Background:
Underserved women are at risk of HIV acquisition, unwanted pregnancy, and poor reproductive outcomes due to numerous socioeconomic and sociocultural factors. These women are often involved with the criminal justice system and many are marginally housed. HIV-infected women may be reluctant to discuss childbearing due to stigma related to disease and lack of knowledge of interventions to reduce mother to child HIV transmission.

Objectives:
To facilitate knowledge of HIV status, risk reduction behavior, and preparation for or prevention of pregnancy in at risk women and HIV infected women in order to optimize reproductive outcomes, prevent unwanted pregnancy, and to reduce mother-to-child HIV transmission.

Methods:
1) Nurse Practitioner facilitates jail sexual health discussion group at San Francisco County Jail in female inmate housing area.
2) Medication list review to screen for potentially teratogenic medications prescribed for HIV-infected women of childbearing age.
3) Integrating preconception discussion into gynecology visits and case conference for multidisciplinary HIV Women's Clinic. Gynecology provider also provides prenatal care for HIV-infected women. Breakfast, primary care, psychiatry, gynecology, and case management are available during this clinic


Results:
1) Women attending jail sexual health discussion group have high acceptance of HIV testing and verbalize increased understanding of sexual and reproductive health.
2) Recommendations for folate supplementation for at risk women taking HIV opportunistic infection prophylaxis trimethoprim-sulfamethoxazole. Recommendations for effective contraception and risk discussion for women of reproductive potential who are taking efavirenz-containing antiretroviral medications due to increased risk of neural tube defects.
3) Gynecology provider identifies at risk women during case conference discussion and conducts individualized preconception discussion during gynecology visits. Clinic is well-attended because basic client needs are served


Conclusion and implications for practice:
By inviting clients in a non-judgemental fashion to discuss reproductive and sexual health, health care providers can facilitate client's avoidance of unplanned pregnancy, optimization of reproductive outcomes, and reduction of mother-to-child HIV transmission through jail health programs and interdisciplinary clinics.