Living With HIV: Your Reproductive Health 

Living with HIV will require you to think carefully about your reproductive health. AllLife outlines important things to consider when you are HIV-positive.

HIV-positive parenting

An HIV-positive person could potentially transfer HIV to their baby throughout pregnancy, delivery, or breastfeeding. Treatment with a combination of HIV medicines called Anti-retroviral Therapy (ART) can prevent the transference of HIV to your baby. HIV can pass through the placenta and infect the foetus. During childbirth, the baby may be exposed to the virus from blood and other fluids. When a woman goes into labour, the amniotic sac breaks and the risk of transmitting HIV to the baby rises during childbirth. 

Living with HIV: Your Baby

One of the first comments from newly diagnosed young women I hear is, ‘I will never be able to have children’. Years ago, this was a concern as medical data and medication were limited. I was older when diagnosed and had already had the joy of having my children. This put me in a position to understand and empathise when someone voiced these concerns as to just how much they thought this was an impossible dream.

Raising a child when HIV-positive

An HIV-positive person could potentially transfer HIV to their baby throughout pregnancy, delivery, or breastfeeding. Being HIV-positive does not mean that you cannot have children. Treatment with a combination of HIV medicines called Anti-retroviral treatment (ART) can prevent transference of HIV to your baby and safeguard your health.

HIV-positive and pregnant

During pregnancy, HIV can pass through the placenta and infect the foetus. During childbirth, the baby may be exposed to the virus from blood and other fluids. When a woman goes into labour, the amniotic sac breaks, increasing the risk of transmitting HIV to the baby, during childbirth.

Preventing HIV transmission to your baby

The good news is that there are many ways to lower the risk of passing HIV to your unborn baby to almost zero. You, the woman in the relationship, may not be the one that is HIV-positive and wondering how to conceive if your partner is the one living with HIV. There are a variety of ways to achieve your purpose.

Undetectable viral load 

When a person living with HIV has an undetectable viral load, there is no risk of HIV transmission during sexual intercourse. Provided your HIV partner has an undetectable viral load (for at least six months after the first ‘durably undetectable’ test.) and neither of you has any Sexually Transmitted Infections/Diseases (STI/STDs), sex without a condom is acceptable.

Detectable viral load

If you or your partner have a detectable viral load it is essential to discuss conception options that reduce or remove the risk of transference during intercourse to you or your partner and baby. Before deciding not to use condoms, get advice from your HIV healthcare providers so that they can establish what would work best for you. 

Pre-Exposure Prophylaxis

One of the options may be to join up with your HIV-negative partner taking Pre-exposure prophylaxis (PrEP). PrEP decreases HIV transmission and is safe to take during pregnancy and breastfeeding.

HIV reinfection

If both partners are HIV-positive, both must have an undetectable viral load to prevent reinfection. Reinfection can lead to transmitted resistance whereby a drug-resistant variant can transfer to a partner. Should this happen, some HIV drugs may not work. 

HIV treatment during pregnancy

Currently, the drugs of choice for HIV-positive people during pregnancy are the antiretroviral drugs: 

  • Dolutegravir 
  • Emtricitabine/Tenofovir Alafenamide Fumarate, (DTG+FTC/TAF). 
  • This combination comprises the safest and most effective HIV treatment regimen, which is currently available during pregnancy.

Mother-To-Child HIV transmission

Overall, the risk of mother-to-child transmission of HIV is 40% in the absence of any intervention. The timing of such transmission is as follows: in utero: 5%; during delivery: 15–20%; up to 24 months of breastfeeding: 20%. https://sahivsoc.org/Guidelines/Module19 . In 21 countries in sub-Saharan Africa surveyed in 2019, the transmission rate varied between 2 and 25%. The countries with the best figures were Botswana, Eswatini, South Africa and Namibia (all below 5%). If you, your partner, or both of you, are HIV-positive, ask your medical service provider for guidance on the most suitable procedure that will suit you and your partner’s situation. 

The next blog post will provide information on breastfeeding vs formula feeding – you decide.

A chronic condition can affect anyone. How you manage it is what makes the difference. You can get life cover of up to 1 million Rand for your chronic health condition and up to 10 million Rand if you are living with HIV. Contact AllLife for more information on how to secure your family’s future.