HIV and Pregnancy
Finding out you are HIV-positive during Pregnancy
All pregnant women are now offered a test for HIV as a routine part of antenatal care. This is because finding out if you do have HIV when you are pregnant means that you can receive treatment that will significantly reduce the chance of passing the infection on to your baby and making sure you stay really well during the pregnancy. If you do not want this test or have any concerns you can discuss this with the medical staff. The test is never done without asking you first.
If you are found to be HIV positive you will be advised to start some tablets at least for the time you are pregnant (and maybe long term if you need it to keep yourself well). This will help keep you well during your pregnancy and will also mean that there is a very small chance of your baby becoming infected with HIV.
Issues for an HIV-positive woman who wants to become pregnant with an HIV-negative man
There is a risk that unprotected sexual intercourse with an HIV-positive woman will lead to infection of a HIV-negative male partner. However, if this is the case and the woman wishes to become pregnant it is possible to prevent the male partner becoming infected if the woman uses a self-insemination kit. This simple procedure involves the woman inseminating herself (basically squirting the semen into her vagina), at the time she is ovulating (producing an egg), with her partner’s sperm which has been collected in a sterile pot.
Most hospitals or women’s health organisations can offer advice and appropriate equipment. It is a good idea to discuss your plans with the healthcare team that look after your HIV. This is especially important if you are on HIV medication or have other health problems. Your HIV team may want to optimise it to make sure if you become pregnant the baby won’t be harmed.
Issues for an HIV-negative woman wishing to become pregnant with an HIV-positive man
If the father is HIV-positive but the mother is not, the baby will not be directly infected from the father’s sperm. But if the woman becomes infected during conception there is significant risk of transmission to the baby.
There are some actions that you can take in these circumstances.
- Normal conception: Some couples may elect to get pregnant by having intercourse like any other couple. This is only recommended when the male is on treatment AND their HIV is fully controlled AND they have been checked for other infection AND that he is producing good quality sperm. The female partner may also take anti-HIV drugs during this time to further reduce the risk of becoming infected with HIV. Couples wishing to conceive in this manner MUST talk to their HIV doctors and nurses before they consider this and get support to make sure they do this safely.
- Sperm washing: One option for couples where the male is HIV-positive and the woman HIV-negative may be sperm washing. A semen sample can be `washed’ and used for insemination. A woman wishing to get pregnant by this method will be monitored to determine when she is due to ovulate, and then her partner will be asked to provide a sperm sample which is washed before testing it for HIV. So far there have been no cases of HIV transmission to the female partner with this method. However, unfortunately, few centres in the UK offer this service and NHS funding remains limited. It is important to note that sperm washing is looked upon as a risk-reduction process and not a fertility treatment.
- Artificial insemination: Another option for a woman who is HIV-negative and whose partner is HIV-positive might be artificial insemination with another man’s semen either from an anonymous donor, or someone known (such as a member of her partner’s family). This is an option that many women use if their partner is infertile or risks passing on other infections.
Issues for HIV-positive couples
Until recently it was thought that pregnancy could have a negative effect on a HIV positive woman’s health as the immune system might be further suppressed by pregnancy. It now seems that pregnancy is only likely to have an impact on a woman’s physical health if she is already unwell, or has very low CD4 counts.
If you are both positive and taking combination treatments it is important to discuss conception and contraception plans with health professionals preferably before conception.
This is particularly important if either of you has resistance to any HIV drugs as there is a chance a resistant strain of the virus could be passed between partners. Also there may need to be changes to your medication to make sure if you become pregnant the baby won’t be harmed by the drugs.
Reducing Infection Risk for the Baby
- A team effort between you and all the people who are there to look after your pregnancy, your baby and you HIV and taking the tablets that are advised mean there is a very small chance of your baby becoming infected with HIV. We currently can get the risk as low as 0.1% (which is the same as saying 1 mother in every 1000 with have a baby born with HIV).
- After birth: All babies born to mothers who are HIV positive will receive a four week course of medication. It is important not to breastfeed your baby and you will be given help to formula feed your baby.
- Your baby will need an HIV test when it is 6 weeks old and then need further tests usually at 3 months and 18 months.
- If your baby is found to have HIV (which is very rare) they can have medication to keep them healthy and they should enjoy a normal happy life able to all the things any child enjoys.
Help, information and support
You will find more detailed information at the links below:
At DHIVERSE we can support you with more information about any of the above and we can also offer practical support in helping you talk to your clinic and other people involved in your treatment and care. We can also accompany you to appointments if necessary.
Other helpful information can be found at:
- NAM is a community based HIV information provider. It has 3 factsheets under the heading reproductive health on: mother to baby transmission, pregnancy and contraception and sperm washing.
A particularly informative fact sheet can be found at: http://www.aidsmap.com/Mother-to-baby-transmission/page/1044918/
- Positively Women
- Terence Higgins Trust