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Many women with HIV are choosing to have children. Although you have HIV, it’s possible for you to have a healthy pregnancy and it is likely your baby will be born healthy and HIV negative. Without antiretroviral treatment or other interventions, about one in four women with HIV transmit HIV to their infants. With effective interventions, the risk of transmission is very low.

There are four recommended steps to reduce the risk of passing on HIV to your baby:

  • Take HIV antiretroviral treatments during pregnancy
  • Don’t breastfeed
  • Consider a caesarean delivery
  • Treat your baby with HIV medications (usually for 4 to 6 weeks)

Generally speaking, the lower your viral load the less likely you are to transmit HIV to your baby. The aim of HIV treatment in pregnancy is to achieve an undetectable viral load. If this is not achieved, a Caesarean delivery will be offered and will usually be performed before you go into labour

Notes on treatments:

  • You must avoid becoming pregnant if you or your partner are taking the Hep C treatment Ribavirin or Rebetron, or if you have taken it during the previous six months.
  • All women are advised to take folic acid when planning to conceive and early during pregnancy. If you are taking a drug called Cotrimoxazole (Septrin or Bactrim) because of an opportunistic infection or as prophylaxis, you may need to take an increased dose of folic acid.
Planned pregnancy

A planned pregnancy can minimise stress, leaving you time to discuss issues with your partner and your doctor to optimise your health and to switch HIV drugs if necessary. It gives you the opportunity to commence health strategies before pregnancy e.g. taking folic acid. It also gives you a chance to sort out any maternity leave entitlements and to make financial arrangements.

Unintended pregnancy

Life doesn’t always go to plan and you may find yourself unexpectedly pregnant. Unplanned pregnancies can range from being an unpleasant shock to a welcome surprise. You have every right to consider all your options.

You may want a baby. You may definitely not want a baby. You may want a baby at some point in the future, but your current health, your work situation or your relationship status might make having a baby just too hard right now. It is your right to decide whether or not to continue with the pregnancy. Pregnancy counselling is available in all states and territories through abortion clinics, women’s hospitals and GPs. If your concerns are related to HIV, it is important to talk to your doctor before making any decisions.

PREGNANCY CHECK LIST

Pregnancy check list

  • Get screened for any genital infections and, if necessary, get treated. If you are sexually active, repeat the STI screening at 28 weeks.
  • Learn about your treatment options and make a plan, including different options related to how well your viral load is controlled during your pregnancy.
  • Learn about your delivery options and get a referral to a doctor with experience in HIV and pregnancy.
  • Make a delivery plan with options related to how well your viral load is controlled during pregnancy.
CONCEPTION FOR SERO-DISCORDANT COUPLES

Conception for sero-discordant couples

In the past, getting pregnant through unprotected sex with an HIV-negative partner was not recommended but there is now clear evidence that being on HIV antiretroviral treatment and having an undetectable viral load can prevent the transmission of HIV. In certain situations, the risk of HIV transmission is low enough that it’s considered safe for a couple to have unprotected sex in order for the woman to become pregnant. This is the case when:

  • you are on antiretroviral treatment and have been taking treatment as prescribed and
  • you have had an undetectable viral load for more than six months and
  • neither you nor your partner has any sexually transmitted infections (STIs) and
  • you only have unprotected sex on the days when you are ovulating (see Knowing your fertile period)

You can further decrease the risk of transmission if your HIV-negative partner takes specifically prescribed anti-HIV drugs around the days you have unprotected sex (pre-exposure prophylaxis or PreP), or if required within 72 hours after unprotected sex (post-exposure prophylaxis (PEP). You and your partner will need to discuss the options with your doctor to find the best course of action in your particular circumstances.

KNOWING YOUR FERTILE PERIOD

Knowing your fertile period

You decrease HIV transmission risk and greatly increase your chances of conceiving if you have any unprotected sex on the days when you are most fertile. This is when you are ovulating and an egg is released from one of your ovaries. Getting to know your body and your menstrual cycle will allow you to estimate and recognise when ovulation happens and increase your chances of getting pregnant.

If you note down the dates of the beginning of each period, you will work out the length of your menstrual cycle. The average length is 28 days, but many women have a cycle that is longer or shorter.

To get a rough idea of when you are ovulating:

  • Work out the date you are expecting your next period to begin
  • Count backwards 16 days
  • Your fertile time begins around that date, and should last for about five or six days

Alternatively, you may be able to identify your fertile time by noting the changes in your vaginal secretions. At the beginning and end of your cycle vaginal secretions are creamy, sticky and thick. As your body prepares for ovulation, they become wetter, thinner, clearer and stretchy like raw egg white. Your breasts may feel tender. You may also experience mild stomach pain and feel bloated. An ovulation kit (like a pregnancy home test) or an ovulation thermometer can be obtained from your pharmacy to help identify when you may be ovulating.

OTHER OPTIONS

Other options

There are other options if you want to avoid unprotected sex. These include self-insemination where the male partner ejaculates into a container and his sperm is then inserted into the vagina using a syringe. It remains important to use this process while you are ovulating.

If your partner is also HIV positive, you may wish to consider ‘sperm washing’. Sperm washing requires the male partner to give a semen sample to a clinic. The sperm (which does not contain HIV) is then separated from the seminal fluid (which does contain HIV), before the sperm is injected into the woman’s uterus. Sperm washing is expensive as it requires the involvement of a fertility clinic, and is only available through the public health system in Victoria. Sperm washing is usually not necessary to prevent HIV infection during conception given the great advances in antiretroviral treatment effectiveness and the availability of PrEP and PEP.

Many couples face problems conceiving regardless of issues associated with HIV infection. If you are concerned about you or your partner’s fertility, you can be referred for specialist fertility advice and assistance. The first step is to talk to you GP.

Having a Baby: A guide for HIV-positive women, men and their partners is a practical resource developed by Pozhet, an organisation for heterosexual people living with HIV in New South Wales. It explores many of the issues people with HIV consider when planning to have a baby. The resource was produced in 2013. It includes technical information on conception that remains correct, but be aware that recent trial results have increased confidence in the unlikelihood of HIV being transmitted to a negative partner if you have a stable undetectable viral load and your partner uses PrEP and/or PEP (see above). Talk to your doctor.

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