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24 November, 2009

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HIV and women - having children

Women who are HIV positive or have an HIV positive male partner can still consider pregnancy, adoption and other ways to have children. HIV can pass from mother to baby during pregnancy, birth or breastfeeding. Women who are HIV positive should seek medical advice before they become pregnant.

Medical intervention may reduce the risk of an HIV positive woman passing HIV to her unborn children. If the woman’s male partner is HIV positive, IVF may be an option.

HIV and pregnancy
In Australia the human immunodeficiency virus (HIV) is most commonly spread through unprotected anal or vaginal intercourse with an infected person. Around 14,800 people are living with HIV infection in Australia, including about 2,000 women.
In some cases, one partner is HIV positive and the other is not. This is sometimes referred to as ‘serodiscordance’. Relationship issues such as sex and having children are complicated for serodiscordant couples and counselling may be helpful.

How HIV is spread
The HIV virus is found in blood, semen (cum), pre-ejaculate (pre-cum), vaginal fluids and breast milk. The virus can pass directly across the lining of the vagina or rectum during sexual intercourse. It can also enter the bloodstream directly if contaminated injecting equipment is used. HIV can also pass from mother to baby during pregnancy, birth or breastfeeding.

Planning a family
Deciding to have a baby is a big decision for anyone. For a woman who is HIV positive or has a male partner with HIV, the decision is more complicated. However, a number of HIV positive women in Australia have given birth to healthy infants.

If you are in this situation, you should try to find out as much as you can before you become pregnant. It may help to talk the issues through with:

A counsellor who specialises in this area
Other women who have been in this situation
The doctor who is treating you.

HIV positive women and conception
Many HIV positive women who want to become pregnant to their HIV negative male partners choose to use artificial insemination at home using their partner’s semen, rather than risk unprotected sex.

You can improve the odds of pregnancy by artificially inseminating at the most fertile time of your menstrual cycle. Your doctor can advise you on the various methods of insemination and calculating ovulation. Ovulation detection kits are available from your local pharmacist and they may help to predict ovulation.

Other options such as foster care, permanent care and adoption may be worth exploring. It is important to be aware that the application process involved with permanent care and adoption may be intrusive and offers no guarantee of receiving a child.

HIV positive men and conception
If a woman’s male partner is HIV positive, she risks infection if they have unprotected sexual intercourse.

The in vitro fertilisation (IVF) technique called intracytoplasmic sperm injection (ICSI) can achieve pregnancy with a low risk of HIV transmission. The partner’s sperm is washed to remove infected fluid and cells. A number of the woman’s eggs (ova) are surgically removed and a single sperm from her partner injected into each. The fertilised eggs are then implanted into the woman’s prepared uterus.

Pregnancy issues for HIV positive women
There is no evidence that pregnancy will change the course of HIV progression for HIV positive women. There is also no evidence to suggest that babies born to HIV positive mothers are more likely to have birth abnormalities.

However, without treatment, up to 35 per cent of babies born to HIV positive women will contract the virus. With medical intervention, the transmission rate from mother to child can be less than two per cent.
Ways to reduce the risk of transmission include:

Antiretroviral drug treatment before conception to reduce the woman’s viral load as much as possible (the lower the viral load, the lower the risk of transmission)
Antiretroviral drugs treatment throughout pregnancy and during labour and delivery
Caesarean section rather than vaginal delivery
Avoiding invasive obstetric procedures where possible
Antiretroviral drugs given to the newborn for around six weeks after birth
Bottle feeding the baby with formula, rather than breastfeeding.

Talk to your doctor about your treatment. It is important to note that not all antiretroviral medications should be used during pregnancy.

Tell your doctor about your HIV status
It is important to tell your doctor or midwife about your HIV status. This helps your health professional to offer you appropriate treatment and allows them to take steps to minimise the risk of accidental transmission during any medical procedures.

After a pregnancy
All babies born to HIV positive mothers will be regularly tested for HIV, usually until the infant is 18 months old. Testing of the baby may involve a combination of antibody and PCR tests. It is important that babies exposed to antiretroviral agents continue to be monitored.

Managing with illness as a parent
HIV can lead to chronic illness at some time in the future. As with any longer term illness, this can impact on a person’s ability to earn an income, manage a household or raise children. Any kind of chronic illness of one partner can be a source of stress in a relationship and sometimes families may need extra support.

Where to get help

Your specialist HIV doctor
HIV and Sexual Health Connect Line Tel. 1800 038 125
HIV, Hepatitis and STI Education and Resource Centre, Alfred Health Tel. (03) 9076 6993
Royal Women’s Hospital, Infectious Diseases Tel. (03) 9344 2000
Royal Women’s Hospital – Chronic Viral Illness Program (for positive males) Tel. (03) 9344 2057
The Victorian HIV/AIDS Service Tel. (03) 9076 6076
Positive Women Victoria Tel. (03) 9076 6918
Straight Arrows Tel. (03) 9076 3792
Victorian AIDS Council Tel. (03) 9865 6700
Positive Living Centre Tel. (03) 9863 0444
People Living with HIV/AIDS Tel. (03) 9865 6772
Melbourne Sexual Health Centre Tel. (03) 9341 6200 or 1800 032 017 or TTY (for the hearing impaired) (03) 9347 8619
Family Planning Victoria Tel. (03) 9257 0100
Sexually Transmissible Infections and Blood-Borne Virus Program, Department of Human Services Victoria Tel. (03) 9096 0000
Victorian Department of Human Services, for information on foster care, permanent care and adoption Tel. (03) 9096 0000

Things to remember

HIV can pass from mother to baby during pregnancy or birth or through breast milk.
With medical intervention, the HIV transmission rate from infected mother to unborn child can be less than two per cent.
If the woman’s partner is HIV positive, IVF may be an option.

You might also be interested in:
HIV and AIDS.
HIV and gay men - safe sex.
HIV and men - safe sex.
HIV and women - safe sex.
HIV testing.
HIV treatment.
Sexually transmissible infections - avoid the risk.
Sexually transmissible infections - overview.
Sexually transmissible infections - signs and symptoms.

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