Your Questions Answered: HIV and Reproduction

Written by: Jen Sloniger
Your Questions Answered is a blog series which addresses Project HOPEFUL blog readers’ most burning questions. Send your questions to: media@projecthopeful.org

Question: How does HIV affect an adult who is married (and therefore sexually active) to a person who is HIV-? How would the couple go about having a child who is healthy without compromising the health of the spouse who is HIV-?
~Anonymous

ANSWER:
A couple where one partner is HIV+ and the other is negative is called an HIV discordant couple. The good news for discordant couples is that there are options available and child-birthing IS possible for them. To help us answer today’s questions regarding conception and reproduction our good friend, Linda Walsh, NP, Clinical Director of the University of Chicago Adoption Center shares some information:

To answer the question about conception depends on which partner (woman or man) is infected with HIV as to what strategy will be utilized. Being on a stable ARV regimen, having an undetectable viral load, not having other STDs all decrease the risk of transmission, but do not eliminate it entirely.

There is a technique called sperm washing [for positive men], also artificial insemination is an option [for protection for either a negative man or a negative woman.] And there is some data on doing it the old fashioned way with an undetectable viral load, etc.

Most of my patients, who are young adults/adolescents, have not used the sperm washing technique. All have been young women who’ve had children that are thus far HIV negative. I have no knowledge of any of their partners becoming positive.

Avert.org tells us more about sperm washing:

This involves separating sperm cells from seminal fluid, and then testing these for HIV before artificial insemination or in vitro fertilisation. Sperm washing is a very effective way to protect both the mother and her baby, but it is only available at a few clinics and can be difficult to access, even in well resourced countries.

About.com adds:

Sperm washing is a technique that was first developed in Milan. The concept of sperm washing rests on the premise that HIV resides mainly in the seminal fluid of an HIV positive male. Sperm washing concentrates and separates the fertilizing sperm from the infectious seminal fluid. During ovulation, the woman is then artificially inseminated with the concentrated sperm. Without the infectious seminal fluid, the theory is that the risk of the woman being infected with HIV is greatly reduced, thereby reducing the risk of vertical transmission (transmission from mother to child) as well.In July, 2010 the World Health Organization (WHO) issued new HIV and AIDS guidelines on PMTCT (preventing mother to child transmission) and on HIV and breastfeeding.

According to the 2010 guidelines, all HIV positive mothers, identified during pregnancy, should receive a course of antiretroviral drugs (ARVs) to prevent mother to child transmission. All infants born to HIV positive mothers should also receive a course of ARV drugs and should be exclusively breastfed for 6 months and complementary fed for up to a year.

The risk of transmission from mother to infant without medications is approximately 30%. With PMTCT medical care that number plummets to approximately 1%.

A great resource for learning about comprehensive care is: HIV/AIDS Care and Counseling by Alta van Dyk . You can read the book online HERE

If you’re enjoying this series let us know in the comments below.

9 responses to “Your Questions Answered: HIV and Reproduction

  1. It’s so awesome to hear that there are ways for them to do this safely! Thank you so much for answering that question. I’m learning so much from this series, already.

  2. This is so helpful! Thank you for helping us be informed and helping us have a heart for these little ones!

  3. love, love, love, love, LOVE this series! keep at it, please.

  4. Wow. I hadn’t even thought of this yet!

  5. Thank you so much for answering these questions. I have had both of the ones you’ve answered so far and they are so incredibly helpful. Can’t wait to read and learn more from the rest of the series. Thanks!

  6. Could you please explain the part about breastfeeding:

    “All infants born to HIV positive mothers should also receive a course of ARV drugs and should be exclusively breastfed for 6 months and complementary fed for up to a year”

    I thought that breastfeeding was one of the ways that the virus was spread.

    Thanks! 🙂

  7. The risks of not breast feeding a child are higher than the risk of getting the virus when mom and baby are on the pmtct medications. According to the WHO all HIV+ mothers are encouraged to breastfeed their babies when receiving medication. Again, the risk of transmission is only approximately 1% on these medications.

  8. Awesome! Thanks for answering that 🙂

  9. I am very interested to read this article. But I think some of these methods should not be considered, even in the difficult situation of a marriage in which one spouse is HIV positive. As a Catholic I believe artificial insemination and in vitro fertilization are morally wrong; first of all it is wrong if the method of obtaining sperm entails masturbation which is always gravely wrong, also because children have a right to be conceived through the unitive “marital act” of their parents. Life begins at conception, even when that is in a laboratory as in vitro fertilization, so in addition to separating conception from the intimacy of the parents there is the additional problem that more children are conceived than the mother has any intention of bringing to birth, and these are eventually destroyed. Although not HIV positive celibate chastity is my own way of life and this may be a moral choice for some. For those HIV positive people who feel called to marriage the self-giving this entails cannot be lived out by use of condoms or other barriers, so natural intercourse is the means by which the mother would conceive, treatment is surely morally obligatory for the infected spouse to reduce the risk, sexual abstinence except for the purpose of conceiving children should be considered, the reality is the other spouse may become infected. A very difficult situation for which anyone can feel compassion, but not a license to do what is immoral.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s