The choice to decide whether or not to have children is an essential human right.
If a woman (or her partner) is HIV positive, there are many ways to reduce the risk of passing HIV to the child during conception, pregnancy, childbirth, or afterwards through breastfeeding. Regardless of which partner is HIV positive (or if both people are HIV positive), the risk of passing on HIV is lowered if certain precautions are made.
For example, if the woman is HIV positive, she can use artificial insemination so that she can get pregnant without putting her partner at risk of contracting HIV. If a man is HIV positive, they can use sperm washing to help make conception safer. There are other very important things you can do to lower risk, so talk to your doctor.
Without taking any precautions, the risk of transmitting HIV from mother to child is about 1 in 3. By taking precautions, that risk becomes less than 1 in 50.
Before you get pregnant: There are some straightforward ways to improve your health before pregnancy, regardless of your HIV status.
Some general tips are:
• Stop smoking, using drugs, or drinking alcohol.
• Eat healthy foods and take a folic acid supplement.
• Get to an ideal body weight.
• Both you and your partner should get a full sexual health screen- and be treated for any sexually transmitted infections.
• You should talk to your doctor about medications- many medications may be harmful for pregnancy.
If you are HIV positive:
• Disclose your HIV status to your partner, if you have not already
• Find a good HIV and Pregnancy specialist who you trust and feel like you can talk openly to.
• Talk to your doctor about HIV treatment
• Plan with your doctor and your partner how you can most safely conceive
• Get your viral load undetectable! Transmission is less likely when a woman’s viral load is undetectable.
Conception (getting pregnant) safely for couples where one or both partners are HIV positive:
Because HIV can live in bodily fluids involved with sex (including semen, vaginal
fluids, and blood), it is important for a couple where one member is HIV positive to minimize the risk of pregnancy.
If the woman is HIV positive and the man is not, the couple may choose to “artificially inseminate”. This could be done in several ways both at home or at the doctor. If you have more questions about artificial insemination, see the i-base website, or talk to your doctor. If a man is HIV positive and a woman is not, they could use sperm washing. Sperm washing is when a lab separates sperm from semen (seminal fluid) so that the sperm can then be put in either the woman’s uterus (women) or directly joined with the egg (in-vitro fertilization).
For couples that are extremely adherent to their HIV medication and have had undetectable viral loads for over 6 months, they may be able to discuss with their doctor ways to time unprotected sex and use of Pre-or Post exposure
prophylaxis (when a person who is not HIVpositive takes HIV medications before or after an exposure to minimize risk of transmission). This option (which is explored more in the Swiss Statement) should be discussed with a doctor first because it depends on individual health.
HIV can be transmitted from a mother to a child (Mother to Child Transmission- MTCT) at three points:
- HIV can be transmitted during pregnancy. Normally, the risk of this happening is very low because the mother and the fetus (baby) do not share blood. Sometimes if the mother has other infections, such as sexually transmitted infections, transmission can occur. Also, any medical procedure that puts a baby into contact with a mother’s blood (such as an amniocentesis) would run a risk for transmission, so pregnant women who are HIVpositive are often
advised to NOT have an amniocentesis.
- HIV can be transmitted during childbirth. In the past, HIV positive women in the UK were encouraged to only have cesarean births. Now, as long as a mother’s viral load is undetectable, there are not other health issues present, and there is no underlying reason for a c-section, an HIV positive woman can safely deliver a baby vaginally. A number of factors determine which birth plan will be more appropriate, so ask your doctor what the best options would be for you.
- HIV can be transmitted during breastfeeding. This is especially true if the mother is not exclusively breastfeeding and is instead switching between formula feedings and breastfeeding. While there are different recommendations around breastfeeding in different parts of the world, UK experts recommend that an HIV positive woman should NOT breastfeed.