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As Mixed-Status HIV Couples Weigh Risks, More Choose to Conceive the Old-Fashioned Way

April 28, 2014

This article was reported by the Washington Post.

The Washington Post reported that more doctors are supporting conceiving the "natural way," by having unprotected sex, for couples where one or both partners are HIV-positive. Until recently, couples have used expensive options such as adoption, surrogacy, or donor eggs or sperm to conceive, to prevent transmission to each other or to their unborn child. With the advancements of drugs that allow an HIV-positive person to maintain an undetectable viral load and an HIV-positive mother from transmitting the virus to her child, as well as only having sex during ovulation, studies support the idea that the risk is extremely low. Conceiving the natural way also is free.

More HIV-positive Americans are living longer thanks to new drugs, and are expressing a desire to start a family. If an HIV-positive mother is on medication, she has a less than 1 percent chance of passing the virus to her child, regardless of the father's HIV status. When only one partner is HIV-positive, the drugs they take reduce their viral load so they will not pass the virus to their partner. The HIV-negative partner also can take a daily medication that reduces the risk of getting infected by their HIV-positive partner. A study presented in Boston earlier this year found no HIV transmission between 750 mixed-status heterosexual or gay couples when the HIV-positive partner was on antiretroviral therapy.

"We have gone from a story of risk reduction to one of possibility," said Shannon Weber, coordinator for San Francisco's Bay Area Perinatal AIDS Center (BAPAC). In 2012, BAPAC started a program to aid couples with the most medically complicated situation, where the male partner is HIV-positive and the female is HIV-negative, to have children.

Some doctors have not yet embraced the practice and argue that while the risk of transmission is low, it still exists and they are worried couples might abandon safe sex altogether. Michael Weinstein, president of Los Angeles-based AIDS Healthcare Foundation, said that while research is promising, HIV viral loads fluctuate and that if a man's viral load spiked while the couple was trying to conceive, then the risk of transmission to the woman would increase drastically.

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