Living with HIV or with a partner who has HIV? Thinking about starting a family? Congratulations on taking this big step! Your first move should be meeting with your doctor to figure out the best option for you and your growing family. But, in the meantime, here are some frequently asked questions about family planning with HIV.
WHAT YOU SHOULD KNOW ABOUT FAMILY PLANNING WITH HIV
CAN I HAVE A FAMILY IF I’M LIVING WITH HIV OR MY PARTNER IS LIVING WITH HIV?
Yes, absolutely! People living with HIV can live long, healthy lives — and those lives can absolutely include babies and children.
WHAT ARE MY OPTIONS IF I WANT TO START A FAMILY?
One of the great things about living in this day and age is that there are a lot of options for starting a family! First of all, you’re not limited to having penis-in-vagina sex. Second, single people, people in same-sex relationships, and friends who want to co-parent together are all potential families. And, finally, being HIV-positive has no bearing on whether or not you can become a parent! In fact, the Americans with Disabilities Act made it illegal to discriminate against a prospective parent because of HIV status.
So here are some options for starting a family when you or your partner is living with HIV. Keep in mind that the cost options vary wildly, from free to hundreds of thousands of dollars.
Getting pregnant at home
There’s always the option to do it the (sort of) old-fashioned way. Couples living with HIV will want to make sure that they are on medication to suppress the virus. It’s also essential to have extensive conversations with your doctor to make sure you’re taking all precautions necessary for a healthy pregnancy and birth before trying to get pregnant.
In addition to penis-in-vagina sex, serodiscordant couples in which the person with a penis does not have HIV and the person with a vagina does have HIV can consider home insemination. This is the “turkey baster” method, where the person with a penis ejaculates into a container and then puts that ejaculate inside the person with a vagina via a syringe or other home insemination tool. Doing it this way protects the person with the penis from exposure to the virus.
And if both partners have vaginas? They can recruit a friend or acquaintance to supply the sperm!
Assisted Reproductive Treatment (ART)
Assisted reproductive treatment (ART — not to be confused with antiretroviral therapy!) isn’t just for couples living with HIV, but it’s absolutely an option. The most common type of ART is in vitro fertilization (IVF), which is when the eggs are extracted and mixed with sperm and then transferred back to the uterus.
IVF includes “sperm washing,” which is when the semen is separated from the sperm. Because HIV lives in the semen, separating it removes the virus. For serodiscordant couples that include an HIV positive person with a penis and an HIV negative person with a vagina, IVF can be a great option as it can help prevent transmitting the virus.
Surrogacy is another form of assisted reproductive treatment that same-gender loving men who are HIV positive may choose. With surrogacy, you’re matched with a surrogate mother and an egg donor, if you need one. The sperm is washed in the same way that it’s washed for IVF, ensuring the health and safety of both the surrogate mother and the fetus.
There are more than 400,000 kids in foster care and 100,000 kids waiting for adoption in the United States. And more babies are born every day that need loving homes. Couples or single people living with HIV can consider giving one those children the home that they deserve by adoption.
CAN COUPLES WHO ARE LIVING WITH HIV BECOME PREGNANT?
Yes. Couples who are living with HIV can become pregnant. Even serodiscordant couples (which means one person has HIV and the other one doesn’t) can get pregnant without passing on the virus to the their partner or to the fetus.
However, every case is going to be different and couples living with HIV should meet with their doctor to plan for a healthy pregnancy and delivery. It’s also important to know that some pregnancy methods are potentially riskier — and more expensive — than others. If you and your partner have decided that conceiving is the way to go, be sure to know what your options are for pregnancy and delivery methods. The CDC has some great information here.
IS IT SAFE TO BE PREGNANT AND LIVING WITH HIV?
Yes. It’s also possible to be HIV positive, pregnant, and not pass the virus on to the fetus.
However, every pregnancy is different and there are certain precautions that people living with HIV need to take in order to protect themselves and their babies. If you’re living with HIV and want to get pregnant, the very first step should be talking with your doctor about how to have a healthy conception and pregnancy.
DO I STAY ON HIV TREATMENT DURING PREGNANCY?
Yes. Antiretroviral treatment (ART) is recommended for all people living with HIV during pregnancy. Staying on top of your medication lowers the chances of perinatal transmission, which is when a parent passes HIV to their baby through their womb. ART is safe during pregnancy and doesn’t increase the risk of premature birth or infant death.
WILL THE PREGNANCY AFFECT MY MEDICATION?
It’s possible that your pregnancy will make your HIV medication less effective, depending on what your medication is. When you’re pregnant, your body may become more efficient at clearing out the medication from the bloodstream. Your doctor can help you adjust your dosage to make sure that you and your baby are protected.
IF I BREASTFEED, WILL MY BABY GET HIV?
The risk of your baby getting HIV if you choose to breastfeed is very, very low as long as you’re taking antiretroviral drugs. But there is a risk, as the breast milk of a person living with HIV does carry HIV.
However, the World Health Organization (WHO) recommends that parents living with HIV who want to breastfeed stay on antiretroviral drugs throughout the time that they’re breastfeeding and until the baby is 12 months old, because the drugs make the viral load low enough to be nearly non-contagious. They also recommend that parents practice exclusive breastfeeding — meaning the baby doesn’t consume any other milks or foods — during the first six months, as research has shown that further reduces the risk of passing on HIV via breast milk.
And, of course, formula is always an option.
DO ALL BABIES BORN TO HIV-INFECTED MOTHERS TEST POSITIVE FOR THE VIRUS?
All babies born to mothers living with HIV test positive for HIV when they’re born, but usually only for a short period of time. That’s because the HIV test does not look for the virus itself. Instead, it looks for antibodies. That means your baby will automatically test positive after birth because he or she was exposed to your HIV antibodies as a fetus. The antibodies can remain in your baby’s body for more than 18 months, but the presence of antibodies doesn’t mean the baby is infected.
Within a few days of delivery, hospitals will take a blood sample from your baby and look for the HIV virus using a polymerase chain reaction (PCR) test. If the test is negative, it should be repeated in a few months to either confirm or dismiss the presence of HIV.
For more information about family planning, visit these helpful sites: