Having a Baby When You Have HIV
Early in the epidemic, people with HIV wrestled with the idea of having children, since there was a 25% chance the infant would be born with HIV. For some women and potential fathers, those odds were too high. Dina M., quoted in a 1991 article in The New York Times, had planned her pregnancy. But then she had second thoughts and had an abortion. "I just didn't know what to do. If I kept the baby my life would have probably ended. If I had the baby, there was the possibility that the baby wouldn't last very long." In the same article, one woman said her doctor in Manhattan, whom she had seen for six years, told her she did not feel "emotionally" she could deliver her baby and referred her elsewhere.
But the results of PACTG Study 076, released in 1994, showed that HIV treatment could dramatically reduce (66%) the chance of an HIV-positive mother passing the virus to her child. Subsequent research and clinical practice have resulted in lowering that risk to less than 1%. In New York State, for example, the number of cases of transmission during pregnancy has declined from 97 cases in 1997 to just three in 2010 -- a transmission rate of 0.7%.
Fortunately, people with HIV now have a number of options when it comes to pregnancy. Unfortunately, some of these options are often out of reach financially for many people. And they may face opposition from friends and family. A 2007 amfAR online survey of people in the U.S. found that only 14% of those between 18 and 44 felt that women with HIV should become pregnant, and a third of all respondents said they would not support that decision at all.
The "Women Living Positive Survey" included 700 women with HIV from across the U.S. When asked about pregnancy, 61% stated that women with HIV can have children if they have the appropriate support. But 59% also felt that society strongly urged them not to have children. In addition, 57% of those who became pregnant did not discuss treatment options with their provider before they became pregnant. They often found information online instead, which, as the post from "Margarita" below shows, can be risky:
"It is very possible to have a child while one partner is positive and the other is negative. As long as the negative partner maintains an undetectable viral load, and you both lead a healthy lifestyle, i.e. exercise, proper diet, limit alcohol use and absolutely no drugs ... even weed, the chance of infection is very low. As an alternative, think about purchasing a juicer! Try juicing fresh veggies and fruits to boost both immune systems. Kale, Carrots, Oranges, Blueberries, Cranberries ... juice at least 3 times a week, you both will see and feel a difference."
Clearly, a completely unproven statement like this needs to be discussed with a care provider. Many in the study had to make changes to their regimen after they became pregnant, instead of learning about their choices beforehand. In her presentation on the study at the Vienna International AIDS Conference in 2010, Dawn Averitt Bridge stated:
"We have laws in place in the U.S. that prevent fertility treatments for HIV-positive women. The assisted reproductive technologies are quite good but, unfortunately, not available to many women and men ... And it's a huge problem. Many of us chose not to have children many years ago, because we were either told we were crazy, or the risks seemed too high. And because people have gotten older, because you had long-term HIV disease, whatever the reasons are, fertility has become a very big issue and a big problem."
The Ethics Committee of the American Society for Reproductive Medicine has stated that health care professionals may be legally and ethically obligated to help women with HIV who choose to become pregnant. They can refer patients to other facilities if they lack the expertise themselves, but a blanket statement of not offering care is no longer acceptable. In 2010, California mandated that all fertility centers provide appropriate fertility interventions to people with HIV or refer the couple to a center that offers such services.
Before You Start
The health of both partners should be evaluated and any problems should be addressed with their primary care provider. There are three different scenarios, and each one has unique issues and choices that affect the man, the woman, and the infant:
- The man has HIV and the woman does not: this places emphasis on preventing the woman from being infected
- The woman has HIV and the man does not: prevention of transmission to the man and to the infant need to be considered
- Both partners have HIV: the emphasis is on preventing transmission to the infant as well as prevention of superinfection between the adults
(It's important to remember that the infant can only acquire infection if the mother has HIV. If the father has HIV and the woman does not acquire it, there is zero risk of infection to the infant.)
In general, the partner with HIV should be taking HIV medication to ensure an undetectable viral load and raise the CD4 count as this decreases the risk of transmission in all three scenarios. If the woman is menstruating there is an increased risk of her transmitting the virus to her partner or for her acquiring HIV. For a man with HIV, there is likely a positive correlation between total sperm concentration and CD4 count. A 10-year study looking back at 181 men found that 42% had an abnormal semen analysis with at least one reading in the subfertile range. Fertility issues occur in both women and men with HIV. In addition, semen testing in men taking HIV meds has found a lower ejaculate volume, decreased sperm movement, and increased abnormal sperm. So some form of fertility testing for both partners may be a smart first step. After that, the couple must decide which of several methods to use.
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