Women who are living with HIV, or whose partner is HIV positive may wish to have children, but may be concerned about the risk of transmission of the virus to her if her partner is positive, or to the baby. Women who are living with HIV or whose partner is HIV positive may still consider pregnancy, adoption and other ways to have children.
Women with HIV should talk with an HIV specialist doctor before
they become pregnant, as medical support can reduce the risk of passing HIV to unborn children to less than one per cent.
Medical advances have made the risk of HIV transmission to a baby very low, but for women with HIV, becoming a mother brings with it challenges beyond what HIV-negative mothers experience. Women living with HIV worry about how to prevent passing on HIV to their baby. They may also feel concerned about the safety of treatment taken during pregnancy and given to the baby after birth.
A mother may fear that the prevention strategies will make it obvious to others that she has HIV – this is especially true for women from countries where HIV is common. Some mothers may feel grief that they cannot breastfeed, or that the whole experience was overshadowed by managing the risk of HIV. Learning about how to look after herself in pregnancy and to keep the baby safe are more complicated for a woman living with HIV, and these too add stress during the pregnancy and afterwards.
There is excellent support for women in Victoria who are considering pregnancy, with a risk of HIV either to themselves or their baby. See the contacts at the end of this factsheet for more information.
How HIV is spread
In Australia, HIV (human immunodeficiency virus) is most commonly spread through unprotected anal or vaginal intercourse with a person who has HIV. HIV can also be passed from mother to baby during pregnancy, birth or breastfeeding.
HIV is found in blood, semen, pre-ejaculate, rectal mucus, vaginal fluids and in breastmilk. The virus can pass directly across the lining of the vagina or rectum during sex. 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. Newborns of women with HIV must be formula fed, due to the high risk of transmission through breastmilk.
HIV and planning a family
Many HIV positive women in Australia have given birth to healthy infants. Deciding to have a baby is a big decision for anyone, but for a woman living with HIV, or who has a male partner with HIV, the decision is more complicated. 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
- the doctor who is treating you
- the Chronic Viral Illness Clinic at The Royal Women’s Hospital in Melbourne.
Conception for women with HIV issues
Recent studies have shown that, where the male partner is HIV positive and the woman HIV negative, the successful use of anti retro-viral therapy (which may be referred to as ART or ARVs) has been shown to be as effective as condom use in preventing HIV transmission, provided:
- neither partner has a sexually transmitted infection, and
- the positive partner has had an undetectable viral load for over six months and
- they have been testing regularly (three to four monthly).
This is great news for people who are thinking about pregnancy. Timing of conception can be discussed with a healthcare provider to increase the chance of getting pregnant while reducing the risk of passing on the virus.
Other methods can be used including the use of ‘sperm washing’ – a procedure in which a machine separates sperm cells (which don’t carry HIV) from the seminal fluid (or cum, which can). The washed sperm is then used to fertilise the woman’s egg using a special catheter inserted into the uterus. In vitro fertilisation can also be used, especially if the man has a low sperm count.
In Victoria, referral to the Chronic Viral Illness (CVI) Clinic at the Royal Women’s Hospital can be made to discuss your options with an HIV physician who specialises in reproductive health. This clinic specialises in helping serodiscordant couples to conceive safely.
HIV and pregnancy
Just over 24, 700 people are living with HIV infection in Australia, including approximately 2,400 women. In some cases, one partner has HIV and the other does 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.
Many women with HIV 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. Learning about fertility awareness will help you to know when you are most likely to conceive. A doctor, sexual health nurse, or fertility specialist can help you learn to recognise your fertile time of the month. You can also purchase ovulation detection kits from your local supermarket or pharmacy, and these can accurately predict the timing of ovulation.
A simple way to get semen into the vagina is to collect the semen in a specimen jar, draw it into a small syringe, and inject it directly into the vagina. If available, a plastic tube (cannula) fitted to the syringe will make this easier.
Pregnancy issues for women with HIV
Pregnancy has not been known to make the progress of HIV in the mother any worse. It also appears that HIV does not cause birth defects. In other words, pregnancy can be relatively safe for both a mother living with HIV and her baby – as long as HIV transmission reduction strategies are followed.
Without treatment, up to 35 per cent of babies born to women living with HIV will contract the virus. With medical support, the transmission rate from mother to child can be less than one per cent.
Ways to reduce the risk of transmission include:
- taking antiretroviral medications (ARVs) before conception to reduce the woman’s viral load (the amount of virus in the fluids of her body) as much as possible (the lower the viral load, the lower the risk of transmission)
- if the woman is not already taking ARVs before pregnancy, she would usually start at around five months pregnant
- avoiding procedures in labour that may scratch or cut the baby’s skin, wherever possible (for example, fetal scalp monitoring)
- giving antiretroviral medications to the newborn for around four weeks after birth
- bottle-feeding the baby with formula, rather than breastfeeding.
Talk to your doctor about your treatment. It is important to know that not all antiretroviral medications are safe during pregnancy.
Options such as foster care, permanent care and adoption may also 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.
Getting approval for permanent care or adoption of children does require potential parents to have good health and a reasonable chance of staying healthy until the child is old enough to be socially and emotionally independent.
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 treatment that is suitable and safe. It also allows them to take steps to minimise the risk of accidental transmission during any medical procedures.
HIV testing of women in early pregnancy is now routine in Australia. Testing should be done with your consent and is offered during your first set of antenatal tests. However, it is best to seek professional advice prior to pregnancy if you are living with HIV.
HIV after birth
All babies born to women with HIV will be regularly tested for HIV, usually until they are 18 months old. Testing of the baby will involve a combination of antibody and PCR (polymerase chain reaction) tests. It is important that babies exposed to antiretroviral medication continue to be monitored. Babies born in Victoria are referred for specialised paediatric support, usually at either The Royal Children’s Hospital or Monash Medical Centre.
Managing 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 in either partner can be a source of stress in a relationship and sometimes families may need extra support.
Where to get help
- Your doctor
- Your community health clinic
- Melbourne Sexual Health Centre Tel. (03) 9341 6200 or 1800 032 017 (toll free from outside of Melbourne only) or TTY (for the hearing impaired) (03) 9347 8619
- Victorian AIDS Council/Gay Men’s Health Centre Tel. (03) 9865 6700 or 1800 134 840
- Victorian HIV/AIDS Service, Alfred Health Tel. (03) 9076 6076
- HIV and Sexual Health Connect Line Tel. 1800 038 125 or TTY: 1800 555 677
- The Centre Clinic, St Kilda Tel. (03) 9525 5866
- Sexual Health Clinic Ballarat Tel. (03) 5338 4500
- Positive Living Centre Tel. (03) 9863 0444 or 1800 622 795 (for country callers)
- Positive Women Victoria Tel. (03) 9863 8747
- Straight Arrows Tel. (03) 9863 9414
- Centre for Culture, Ethnicity and Health Tel. (03) 9418 9929
- Chronic Illness Viral Clinic, The Royal Women’s Hospital Tel. (03) 8345 3200
- Department of Human Services, Victorian Government – for information on foster care, permanent care and adoption Tel. 1300 650 172
Things to remember
- HIV can pass from mother to baby during pregnancy or birth or via breast milk.
- With medical support, the HIV transmission rate from infected mother to unborn child can be less than one per cent.
- If the woman’s partner has HIV, IVF may be an option. Options such as foster care, permanent care and adoption may also be worth exploring.