Living with HIV does not have to impact an individual's ability to have children. Family planning, or more specifically, being able to make the choice on whether or not to have a child and taking the appropriate steps to carry out that choice, is an option that is available for those living with HIV.
It’s also important to remember that family planning choices are dynamic and can change over time. If a person doesn’t want to start a family at the moment, they can still change their mind later, and vice versa. No matter what stage you’re at or what preferences you (and your partner) have, there are some important considerations when it comes to family planning.
Pregnancy for women who are HIV-positive
If you are a woman living with HIV, you can still have a healthy pregnancy. If you regularly take ART (antiretroviral therapy) exactly as prescribed by your healthcare provider, the risk of transmitting the virus to the fetus can be 1 percent or lower.1 The risk becomes lower and lower the sooner you start ART, and if you’re already on ART, your current medication may not even need to be adjusted. Current guidelines in the United States require all women to get tested for HIV when they get pregnant.
If you receive an HIV diagnosis at the time of testing, you can start ART immediately. Prior to pregnancy, you can still get tested for HIV if you think you may have experienced a transmission event. ART can be started at any time before a baby is conceived.1,2 Since HIV can, in theory, be transmitted through breastmilk, women who are HIV positive are encouraged to avoid breastfeeding.
If you are HIV-positive and your partner is HIV-negative, there are steps that can be taken to reduce the risk of transmitting the virus to your partner. Taking ART exactly as prescribed may lead to a viral load (amount of HIV in the bloodstream) that is undetectable. When a person’s viral load is undetectable, their risk of transmitting the virus is essentially zero. This idea is referred to as U=U, or undetectable=untransmissable.3-5 Additionally, your partner can take PrEP (pre-exposure prophylaxis), a daily medication used to further reduce an individual’s chances of getting the virus.6
Pregnancy with a partner who is HIV-negative
Similar to the situation described above in which one partner has HIV and the other doesn’t, you may be in a situation in which having unprotected sex to conceive a baby might put you at risk for getting the virus. As mentioned previously, if the HIV-positive partner is regularly taking ART and is deemed undetectable, the risk of transmission is essentially zero. Additionally, the partner who is HIV negative can take PrEP in order to reduce their risk even further.6 Avoiding sex when any open sores are present and avoiding rough sex where tearing and/or bleeding could occur may also help reduce the risk of transmission.
I do not want to have children at this time
Effective contraceptive methods exist for those who are not currently interested in pregnancy. Barrier contraceptives, like latex or polyurethane condoms provide both barrier protection and reduce the risk of getting pregnant. Contraceptives like hormone-containing pills (such as the combination birth control pill or the progesterone-only birth control pill), intrauterine devices (IUDs), implants, and injections can all be used to prevent pregnancy.
The important thing to remember is that these methods only prevent pregnancy, and do not prevent transmission of HIV or other sexually transmitted infections (STIs). For both HIV and pregnancy prevention, barrier and hormonal contraception may be required.2,7 If you or your partner are taking ART as prescribed or are taking PrEP, talk with your healthcare provider about your risk of transmission during unprotected sex.
Finding the right healthcare provider
A critical step in the family planning process is to find a supportive and knowledgeable provider to assist you along the way. An OB-GYN (obstetrician gynecologist) is a doctor who specializes in the care of women and pregnancy. Other healthcare professionals in the OB-GYN field such as nurse practitioners or physician assistants may be able to assist, as well as family medicine or general medicine providers.
Regardless of the healthcare provider you choose, it’s important that they are familiar with HIV care. You can ask your provider how comfortable they feel caring for someone who is HIV-positive, especially during pregnancy. If you feel as though your provider is knowledgeable, and respects and listens to you, they are most likely a good choice to support you during this time.