HIV and Getting Pregnant
Are you living with HIV (HIV+) and interested in having children? Then know that you are not alone. The majority of HIV+ women are of child-bearing age. Advances in HIV treatment have greatly lowered the chances that a mother will pass HIV on to her baby (known as the rate of vertical transmission, mother-to-child transmission, or perinatal transmission). The chances of passing HIV from mother to baby can be as low as 1 in 100 when certain steps are taken (see below for more detail).
These same advances have made it much more possible for HIV+ people to live longer, healthier lives. They have also made it possible to reduce the chance of passing HIV to a partner when trying to have a child (see below for more details). As a result, it is no surprise that HIV+ women and men are interested in having children. A 2009 study showed that almost 70 percent of HIV+ women (ages 18 to 52) living in Toronto, Canada wanted to give birth. The Women Living Positive Survey found that the same percentage of HIV+ women in the United States considered family planning an important part of their HIV care.
Despite the numbers of HIV+ people who want to get pregnant, there is limited access to information, options, and therapies. Many health care providers are not discussing family planning with their HIV+ patients. Some do not have adequate information to share, while others openly discourage their HIV+ patients from having children. In the United States, some laws prevent access to fertility treatments for those living with HIV, and many insurance plans do not cover these procedures. Despite the challenges you may face when wanting to get pregnant, it is possible for HIV+ people to have children. When choosing to have a child as an HIV+ person, it is important to be an advocate for yourself and your future child. Finding the right health care provider who is supportive of your plans to get pregnant is a big first step!
There are several different options for reducing the chances of passing on HIV while trying to get pregnant. The links below outline the risks and benefits of each option to help you understand what might be the best for you, and to prepare for discussions with your health care provider. The options fall under one of two categories: serodiscordant partners or seroconcordant partners:
- Serodiscordant (HIV+/HIV-negative) partners: Serodiscordant refers to couples in which one person is HIV+ and the other is not. Sometimes, serodiscordant partners are referred to as "magnetic couples" or "mixed status couples." You can lower the risk of passing HIV to the baby or uninfected partner by reducing your viral load (or your partner's) before trying to become pregnant. Having an undetectable viral load lowers transmission risk, but does not get rid of the risk altogether. Treating any sexually transmitted diseases (STDs) before trying to get pregnant will also lower your chances of passing HIV between partners. If you are an HIV+ person in a same-sex relationship, some of the information about alternative insemination techniques may be helpful to you as well.
HIV-negative members of serodiscordant couples can also now consider using Truvada (tenofovir/emtricitabine) as Pre-Exposure Prophylaxis, or PrEP. PrEP means taking medicine before being exposed to something to prevent yourself from getting a disease or condition. In July 2012, the US Food and Drug Administration (FDA) approved the daily use of Truvada as PrEP for sexually active adults at risk of HIV infection.
The US Department of Health and Human Services (DHHS) now recommends that serodiscordant couples consider using PrEP as an additional tool to help reduce sexual transmission of HIV while trying to conceive. We do not know yet, however, how useful PrEP is in further reducing the risk of spreading HIV to the uninfected partner when the HIV+ partner is already on HIV drugs, since this has not been studied.
The DHHS also recommends semen analysis for HIV+ men before trying to get pregnant. Men living with HIV have fertility problems more often than HIV-negative men. Checking your fertility can help you and your partner choose the best method for getting pregnant. However, it can be difficult to find a facility willing to analyze an HIV+ man's semen (see below for help finding facilities and providers).
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