Getting Pregnant: HIV-Positive Man and HIV-Negative Woman (Serodiscordant)
It is important to remember that no matter how low the HIV+ partner's viral load -- even if it is undetectable -- there is always some risk of passing HIV to the uninfected partner with any type of unprotected sex. If you choose this method, the risk of passing on HIV is lower if you only have unprotected sex when the woman is ovulating (when she is most likely to get pregnant).
The risk of passing HIV to an uninfected partner may also be reduced when the HIV+ member of the couple takes HIV drugs (continuous combination antiretroviral treatment), even when he or she has no symptoms and a relatively healthy immune system. Recent studies of serodiscordant heterosexual ("straight") couples showed that HIV drugs were very effective in preventing HIV transmission to the uninfected stable partner of someone with HIV.
Another way to reduce the risk of passing HIV to an uninfected partner is to have the HIV-negative partner take 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 for 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.
If you intend to have unprotected sex, it is important to tell your sexual partner that you are HIV+. Exposing someone to HIV without telling them you are HIV+ can result in serious legal action being taken against you.
Offering a permanent family to a parentless child may be an option if having biologic offspring is not a good choice for you. Adoptions can be done within the US or internationally. Some agencies and/or countries may have prejudices against HIV+ people adopting children.
Finding a Provider and Building a Support Network
Regardless of your HIV status, choosing to have a child can be a very difficult and very exciting decision. While having a supportive relationship with a knowledgeable health care provider is a good idea for any potential parent, for people living with HIV it is even more important. A friendly health care provider can talk with you about many issues around pregnancy and having children: which option is right for you, appropriate HIV treatments for you and/or your partner, whether to disclose your HIV status to others (including other providers, your child's pediatrician, additional friends and family), and how to handle the stigma and fear around being HIV+ and pregnant.
Unfortunately, it can be difficult to find a friendly health care provider who is knowledgeable about HIV and pregnancy. Some health care providers simply are not aware of the wealth of information about pregnancy planning for their HIV+ patients. Perhaps even more challenging, though, are the judgmental attitudes still held by many health care providers. When The Well Project's Founder, Dawn Averitt Bridge, asked providers about getting pregnant, she faced some very negative reactions before she found a wonderful provider who supported her desire to have children. For more about Dawn's experience in trying to get pregnant, and subsequently, having two healthy HIV-negative daughters, please read the links below:
- HIV and Pregnancy: Tough Choices and the Right to Choose (Journal of the Associate of Nurses in AIDS Care, Vol. 13, No. 3, May/June 2002, 11-12 courtesy of the Sophia Forum)
- Breaking the Taboos: Pregnancy Planning and Fertility Issues for PLWHAs in the US (transcript from presentation at AIDS 2010 in Vienna, Austria, courtesy of TheBody.com
- Baby Love (POZ magazine, December 2002)
The Well Project has started a list of friendly family planning providers who are informed about pregnancy planning for HIV+ people. Even though the providers listed might not be in your area or town, it might be worth a call or email to answer any questions you might have or for possible referrals. You can also contact Shannon Weber with the Perinatal HIV Hotline at firstname.lastname@example.org for questions about pregnancy planning and resources for people living with HIV.
Given the existing stigma against HIV+ people having children, you may encounter judgmental responses from others. Therefore, it is important that you build a strong support network of loving family, friends, and providers. Your support network can help you make good decisions and weather the negative, sometimes disheartening moments. If you do not have a good number of friends and family who support you, you may consider starting your own support group; for more information, see our info sheet "Starting a Support Group."
Ultimately, you get to choose when and whether to have children. You deserve to be treated with respect and given access to the information necessary to make an informed decision and plan for your future.
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