Many people living with HIV have children who are HIV negative. There are different ways that one can greatly reduce the risk of the virus being passed on to a child depending one's condition. This may vary from couple to couple.
I am HIV positive. Will this affect my sperm count?
Men living with HIV may have a low sperm count and be infertile. Also women with HIV might find it difficult to conceive. However there are many treatment options available. People living with HIV should get professional advice.
It is possible to get pregnant if you have HIV, and to have a healthy baby. If you do not wish to get pregnant, you should use a condom when you have sex. If you do wish to get pregnant, you should speak to your healthcare worker about how to do so safely.
Fertility and Conception
Sero-discordant couples are when one partner is negative and the other is positive
The risk of a baby being born HIV positive is related to the HIV status of the mother, not the father. If a father is positive, is on ART and is virally suppressed there is very little risk that he will pass the virus onto the mother. The couple should have unprotected sex when the woman is ovulating as this will increase her chances of falling pregnant .
Falling pregnant when you have HIV
Many people living with HIV have children who are HIV negative. There are different ways that you can greatly reduce the risk of the virus being passed on to a child depending on your condition. This may vary from couple to couple. Before you try to fall pregnant discuss your options with a doctor.
If the father is HIV positive and is virally suppressed: The risk of a baby being born HIV positive is related to the HIV status of the mother, not the father. If a man is positive, is on ART and is virally suppressed; then there is very little risk that he will pass the virus onto the mother. However, to be safe if they are having unprotected sex the man must have been be virally suppressed for at least 6 months.
If the father is HIV positive and not virally suppressed: If the man is not virally suppressed, the woman can take pre-exposure prophylaxis (PrEP) for the period that they are trying to conceive. This is a preventative medication which prevents HIV from reproducing in your body. It is sold under the name of Truvada and has to be prescribed by a doctor. You have to take it daily for it to be effective. It can lower the risk of infection via sexual intercourse by 90%.
If the mother is HIV positive: There is a risk of mother-to-child transmission where a woman can pass the virus onto the baby during the pregnancy, during childbirth or when breast-feeding. However, if she starts treatment within the first three months of her pregnancy, she will be virally suppressed by the time she gives birth. This will mean that the chances of her baby being born with HIV are less than two in 100. The baby can also be given treatment for the first four weeks of their life.
If both parents are HIV positive: If both partners are on ART and are virally suppressed they can have a baby that is HIV negative if the mother is on treatment. ART is given to all pregnant women who test HIV positive, regardless of their CD4 count. ART reduces the risk of a baby being infected with the virus. Mothers are encouraged to continue with lifelong ART so that they remain healthy and are able to parent their child.
What to do if you think you are pregnant
It is best to go an antenatal clinic as soon as you think you are pregnant. If you do not know your status you will be offered an HIV test. Going to the clinic will also give the healthcare worker a chance to treat and manage any other medical conditions you have, such as high blood pressure, and other pregnancy-related complications.
How often should a pregnant woman go to an antenatal clinic?
Pregnant women should make at least four visits to an ante-natal clinic before the birth of their child because:
- if a woman attends a clinic within the first 3 months of her pregnancy, she can be tested for HIV . If she tests positive she must have a CD4 count blood test as soon as possible and these must be continued throughout her pregnancy.
- if she is HIV positive highly active antiretroviral treatment should be started immediately.This will reduce the risk of mother-to-child transmission
to less than 2%.
- Visiting a clinic early a pregnancy allows doctors to treat other medical conditions or complications that may arise such as high blood pressure.
What happens at each visit
The first visit
- A full medical history and examination, especially problems the woman might have had in other pregnancies or other medical conditions.
- Establish how many months pregnant the woman is.
- HIV test and screening for STIs or other illnesses.
- An ultrasound examination of the fetus
The second visit
If the results of any of the tests or screenings weren't available the patient should return after 2 weeks. The results of the tests will be discussed with the patient as well as possible risks.
The follow up visits
Patients should visit the clinic
- if they are experiencing problems.
- from 28 weeks on the fetus should be checked regularly. If they are low risk and live far from the clinic they need not visit the clinic as often
- at 28, 34 and 41 weeks as there are problems which can arise at these stages of the pregnancy.
- From 36 weeks every 2 weeks if it is a first pregnancy because there is a risk of high blood pressure associated with pregnancy
If you test negative:
- You will be counselled about how to stay negative;
- You will be asked to come back for a repeat test at 32 weeks, and then every three months while you are pregnant and when you are breastfeeding.
If you test positive:
- You will be given counselling about ART and how you can prevent your baby from getting HIV before and after childbirth;
- You will have a CD4 count and viral load test. These will be repeated throughout your pregnancy to make sure that the treatment is working and you are virally suppressed.
- Unless you have TB, which needs to be treated first, ART can be started immediately. This will reduce the risk of mother-to-child transmission to less than 2%;
- If you are already on lifelong ART you will continue with your treatment;