Guide to HIV, Pregnancy and Women's Health: Background and General Questions
This booklet aims to help you get the most out of your own treatment and care if you are considering pregnancy or during your pregnancy.
We hope that the information here will be useful at all stages -- before, during and after pregnancy. It should help whether you are already on treatment or not. It includes information for your own health and the health of your baby.
You may be reading this guide at a very confusing and hard time in your life. Finding out either that you are pregnant or that you are HIV positive can be overwhelming on its own. It can be even more difficult if you find out about both at the same time.
Both pregnancy and HIV care involve many new words and terms. We try our best to be clear about what these terms mean and how they might affect your life.
On an optimistic note, it is likely that no matter how difficult things seem now, they will get better and easier. It is very important and reassuring to understand the great progress made in treating HIV. This is especially true for treatment in pregnancy.
There are lots of people, services and other source of information to help you. The advice that you receive from these sources and others may be different to that given to pregnant women generally. This includes information on medication, Caesarean section (C-section) and breastfeeding.
Most people with HIV have some time to come to terms with their diagnosis before deciding about treatment. This may not be the case if you were diagnosed during your pregnancy. You may need to make some decisions more quickly.
Whatever you decide to do, make sure that you understand the advice you receive. Here are some tips if you are confused or concerned as you consider your options:
- Ask lots of questions.
- Take your partner or a friend with you to your appointments.
- Try to talk to other women who have been in your situation.
The decisions that you make about your pregnancy are very personal. Having as much information as possible will help you make informed choices. You can only make these decisions after learning all you can about HIV and pregnancy, and with your healthcare team.
I was diagnosed via antenatal testing when I was three months pregnant. What a time to receive bad news! I had a lot to think about and at the same time start treatment straight away.
The support I got from my group was invaluable in helping me appreciate the treatment and take it as prescribed. The thought of having a healthy baby made me determined to follow everything in detail.
I had a bouncing HIV negative baby boy thanks to ARVs.
After he was born I stopped my medication, on my doctors recommendation, as I did not need it for myself. My CD4 is quite good (above 600) and I had an undetectable viral load at the time of my baby's delivery.
-- Jo, London
Yes, and HIV treatment makes this much safer.
Women around the world have safely used antiretroviral drugs in pregnancy now for almost 20 years. Currently this usually involves taking at least three antiretroviral drugs, which is called combination therapy, ART or HAART.
Antiretrovirals have completely changed the lives of people with HIV in every country where they are used.
Treatment has had an enormous effect on the health of HIV positive mothers and their children. It has encouraged many women to think about having children (or having children again).
I've often said that having an HIV diagnosis does not change who you are. Like many young women I had always wanted to be a mother. In some way, having a positive diagnosis made me think about it even more.
I had my baby five years after I was diagnosed. That was way back in 1998. I guess I was lucky in a lot of ways because by the time I made the decision to have a baby I'd had a lot of peer support, information and met a lot of other HIV positive women, who also had either been diagnosed antenatally, or had children after their diagnosis.
One of the most difficult things during and after my pregnancy was the uncertainty about whether -- even taking up all the interventions that were available to me -- my baby would be born HIV-negative.
I cannot describe my feelings when I finally got the all clear for my beautiful baby. All the worry, fear and uncertainty were definitely worth the wait!
-- Angelina, London
The exact way that transmission (when the virus passes from one person to another) from mother to baby happens is still unknown.
Mother to baby transmission is known as vertical transmission. The majority of vertical transmissions happen near the time of, or during, labour and delivery (when the baby is being born). Vertical transmission can also occur through breastfeeding.
Certain risk factors seem to make transmission much more likely. The biggest of these is the mother's viral load, which means the amount of virus in your blood.
As with treatment for anyone with HIV, one important goal is to reach an undetectable viral load. Viral load tests measure the amount of virus in your blood. The measurements are in copies per millilitre (copies/ mL). Undetectable viral load is currently considered to be below 50 copies/mL. When we talk about an undetectable viral load in this guide, that is what we mean. If a mother's viral load is undetectable when her baby is born, the risk of vertical transmission is almost zero.
This is particularly important at the time of delivery. Other risk factors include premature birth and lack of prenatal HIV care.
Practically all risk factors point to one thing: looking after mother's health.
Some key points to remember:
- The mother's health directly relates to the HIV status of the baby.
- Whether the baby's father is HIV positive will not affect whether the baby is born HIV positive.
- The HIV status of your new baby does not relate to the status of your other children.
It is now recommended in many parts of the world. In the UK, healthcare providers have been required since 1999 to offer and recommend that all pregnant women have an HIV test. This is now part of routine prenatal care.
It is important for a woman to take an HIV test when she is pregnant. Her ability to look after her own treatment, health and well being is improved when she knows if she has HIV or not.
This knowledge also means that, if she tests positive, she can be aware of how she can protect her baby from HIV.
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