Infertility Among Men Living with HIV in Sub-Sahara Africa; Bridging Evidence and Practice Gaps.
- 1Department of Physiology, Faculty of Biomedical Sciences, Kampala International University, Western Campus, Bushenyi, Uganda.
- 2Department of Anatomy, School of Medicine and Pharmacy, University of Rwanda, Huye, Rwanda.
Abstract
Male infertility is an important component of the global burden of infertility and remains an under-addressed reproductive health concern in sub-Saharan Africa (SSA). The increasing number of men living with Human Immunodeficiency Virus (HIV) following expanded access to antiretroviral therapy (ART) has heightened the need to address their reproductive goals and fertility-related needs. However, the intersection of HIV, male infertility, and access to fertility care remains inadequately characterized in the region. This review examined the biological, clinical, sociocultural, economic, and health-system factors influencing the management of male infertility among men living with HIV (MLWH) in SSA and identified key gaps in evidence and service delivery. A structured literature search was conducted in PubMed, Scopus, Web of Science, Google Scholar, and African Journals Online (AJOL) for studies published between 2000 and 2026. English-language studies addressing male infertility in the context of HIV, including biological, clinical, sociocultural, economic, or health-system factors, were considered. Studies were screened by title and abstract followed by full-text assessment. Findings were thematically synthesized across biological and ART-related reproductive effects, diagnostic and treatment limitations, sociocultural barriers, economic constraints, and health-system challenges. Due to substantial heterogeneity in study designs, populations, outcomes, and settings, findings were synthesized narratively. The review identified interacting biological, social, economic, and health-system factors that complicate infertility management among MLWH in SSA. HIV infection has been associated with alterations in semen quality and reproductive function, although findings are heterogeneous and do not establish that HIV or ART uniformly causes male infertility. Evidence regarding ART remains inconsistent and may vary according to regimen, treatment duration, and study population, with limited evidence from contemporary regimens and few longitudinal male-focused studies from SSA. Major barriers to care include HIV- and infertility-related stigma, gendered perceptions of infertility, limited male engagement in reproductive healthcare, fragmented HIV and fertility services, inadequate diagnostic and laboratory capacity, shortages of trained healthcare professionals, limited availability and affordability of assisted reproductive technologies, and substantial out-of-pocket costs. Inadequate policy integration further limits access to comprehensive fertility care. Male infertility among MLWH in SSA reflects interacting biological and structural challenges. Current evidence does not support the assumption that ART generally impairs male fertility, while regimen-specific evidence remains limited. Strengthening integrated HIV and reproductive health services, improving diagnostic and workforce capacity, reducing financial and stigma-related barriers, and generating longitudinal male-focused evidence from SSA are essential for improving reproductive care and supporting the reproductive rights of MLWH.
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BibTeX
@article{adeniyi2026infertility,
title = {{Infertility Among Men Living with HIV in Sub-Sahara Africa; Bridging Evidence and Practice Gaps.}},
author = {Ismahil Adekunle Adeniyi and Umar Uthman Shehu and Emmanuel Orire Ikuomola and Tagwa Norain Mahmoud and Victor Bassey Archibong and Ibe Michael Usman},
journal = {Research and reports in urology},
year = {2026},
month = oct,
doi = {10.2147/rru.s635913},
url = {https://europepmc.org/article/MED/42953762},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Infertility Among Men Living with HIV in Sub-Sahara Africa; Bridging Evidence and Practice Gaps.
AU - Ismahil Adekunle Adeniyi
AU - Umar Uthman Shehu
AU - Emmanuel Orire Ikuomola
AU - Tagwa Norain Mahmoud
AU - Victor Bassey Archibong
AU - Ibe Michael Usman
PY - 2026
DA - 2026/10/24
JO - Research and reports in urology
DO - 10.2147/rru.s635913
UR - https://europepmc.org/article/MED/42953762
AB - Male infertility is an important component of the global burden of infertility and remains an under-addressed reproductive health concern in sub-Saharan Africa (SSA). The increasing number of men living with Human Immunodeficiency Virus (HIV) following expanded access to antiretroviral therapy (ART) has heightened the need to address their reproductive goals and fertility-related needs. However, the intersection of HIV, male infertility, and access to fertility care remains inadequately characterized in the region. This review examined the biological, clinical, sociocultural, economic, and health-system factors influencing the management of male infertility among men living with HIV (MLWH) in SSA and identified key gaps in evidence and service delivery. A structured literature search was conducted in PubMed, Scopus, Web of Science, Google Scholar, and African Journals Online (AJOL) for studies published between 2000 and 2026. English-language studies addressing male infertility in the context of HIV, including biological, clinical, sociocultural, economic, or health-system factors, were considered. Studies were screened by title and abstract followed by full-text assessment. Findings were thematically synthesized across biological and ART-related reproductive effects, diagnostic and treatment limitations, sociocultural barriers, economic constraints, and health-system challenges. Due to substantial heterogeneity in study designs, populations, outcomes, and settings, findings were synthesized narratively. The review identified interacting biological, social, economic, and health-system factors that complicate infertility management among MLWH in SSA. HIV infection has been associated with alterations in semen quality and reproductive function, although findings are heterogeneous and do not establish that HIV or ART uniformly causes male infertility. Evidence regarding ART remains inconsistent and may vary according to regimen, treatment duration, and study population, with limited evidence from contemporary regimens and few longitudinal male-focused studies from SSA. Major barriers to care include HIV- and infertility-related stigma, gendered perceptions of infertility, limited male engagement in reproductive healthcare, fragmented HIV and fertility services, inadequate diagnostic and laboratory capacity, shortages of trained healthcare professionals, limited availability and affordability of assisted reproductive technologies, and substantial out-of-pocket costs. Inadequate policy integration further limits access to comprehensive fertility care. Male infertility among MLWH in SSA reflects interacting biological and structural challenges. Current evidence does not support the assumption that ART generally impairs male fertility, while regimen-specific evidence remains limited. Strengthening integrated HIV and reproductive health services, improving diagnostic and workforce capacity, reducing financial and stigma-related barriers, and generating longitudinal male-focused evidence from SSA are essential for improving reproductive care and supporting the reproductive rights of MLWH.
SN - 2253-2447
ER -