There are effective options for couples wanting a baby if you or your partner has HIV. With HIV medications and technology, it is possible to prevent HIV passing between men and women when trying to fall pregnant. Also, with medical management and following guidelines, such as being on HIV treatment and not breast feeding, the chances of an HIV-positive female passing the virus to her baby are extremely low.
Options for falling pregnant
Options for men and women are included in the new Pozhet resource: Having a Baby: a guide for HIV positive women, men and their partners
If the female is positive
Self insemination – This involves the man ejaculating (cumming) into a container and drawing the semen into a syringe (without the needle) and then putting it into the woman’s vagina.
If the male is positive
Assisted reproduction: Sperm washing – This involves spinning a male’s semen in a special machine, which separates or ‘washes’ the sperm from the seminal fluid. This is done because only the seminal fluid contains HIV. The sperm cells, which do not contain HIV, can then be used to inseminate the egg. Conception is not assured with this option. It is also expensive and not available in NSW.
Using donor sperm – Some people may choose to use donor sperm. In NSW, new laws mean a child can find the identity of the donor when they turn 18. For those couples that use sperm donated from a friend or family member, there are some tests that need to occur. It’s also important to work through the legal and emotional implications of arrangements with donors who you know.
Recent studies have indicated that if a partner with HIV in a relationship has an undetectable viral load, there is a greatly reduced risk of transmission. Therefore, after careful discussion with an HIV specialist, some couples who want to fall pregnant choose to have unprotected sex around the time of ovulation.
It is important that you inform yourself and talk to your doctor before making a decision about whether you are prepared to try to conceive this way. You should ensure the positive partner’s viral load is consistently undetectable for six months and that neither partner has any other sexually transmissible infections.
PrEP which stands for pre-exposure prophylaxis can be taken before a potential exposure. People who do not have HIV can have a pill daily to prevent getting HIV. For example a couple may be attempting to conceive and the negative partner can take a course of PrEP to reduce any potential risk of transmission from the partner with HIV.
International trials have shown that it is effective for use by heterosexual couples where one partner is positive and for men and women who may have sex without condoms and/or who inject drugs or have a partner at risk of HIV. It is also effective for couples trying to conceive. Truvada (the drug used as PrEP) has not yet been licensed for use by negative people as a prevention treatment (PrEP) in Australia. It is licensed for use as a HIV treatment for people with HIV. The USA has approved the use of PrEP and there are limited ways of accessing PrEP in Australia. We will keep you updated about the situation in Australia.
Protecting your baby
These techniques, used together, are highly effective at preventing mother-to-child transmission:
- Medications – If you’re a pregnant you should stay on HIV medication, or start taking some after consulting with an HIV specialist. Newborn babies to HIV-positive mothers are given a small amount of HIV medication for 4 weeks
- Delivery – Women with an undetectable viral load are able to deliver the baby vaginally. If a woman’s viral load is over 1,000 a caesarian birth is recommended
- Avoiding breastfeeding – HIV-positive mothers should not breastfeed
Having a Baby: a guide for HIV positive women, men and their partners is a comprehensive resource for women and men affected by HIV. It covers low-risk conception and birth, fertility issues and adoption and foster care options.