HIV

Q: Can a couple in which one person is HIV positive conceive a baby without the uninfected partner becoming infected?

Many couples in which one person is HIV positive and the other person isn't want to have children. With careful planning, it is possible to have a safe and successful pregnancy while preventing HIV from passing to the HIV-negative partner (or to the baby). It is very important to discuss your desires and intentions for childbearing with your health care provider before the woman decides to become pregnant. Your provider can help with decisions about how to conceive safely (if your provider is not familiar with reproductive issues for HIV, ask to see an HIV specialist).

If you are a woman with HIV and your male partner is HIV negative

A safe and "low-tech" method is to do home insemination using your partner's semen and a needleless syringe, timed with your ovulation. This can be done in the clinic, if you do not feel comfortable doing it at home. Your partner has no possible exposure to HIV with this method.

Fancier approaches are not really needed in this situation unless you and your partner have fertility problems. If you have concerns, you can seek advice and assistance at a fertility clinic or an HIV clinic with experience in preventing perinatal (mother-to-child) transmission of HIV. They may offer insemination services (these services are legal in some states for couples with one HIV-positive partner, but not in all states).

Approaches that involve unprotected sex between the partners can be safe as far as HIV transmission is concerned. Some strategies reduce the likelihood of infection to near zero, though they are not proven to be 100% reliable. Transmission may occur in rare cases. The following approach can be considered, though it has not been studied thoroughly in the context of trying to conceive a baby.

• The woman who is living with HIV takes anti-HIV drugs and has an undetectable viral load; this minimizes the risk of infecting her partner. The couple then has sex without a condom, limited to the time the woman is ovulating (this reduces the number of times they have unprotected sex and thus lowers the risk of HIV transmission). In addition, the HIV-negative male partner may take HIV medications to reduce his risk of infection with HIV, beginning before attempts at conception and continuing afterward (this is called pre-exposure prophylaxis or PrEP), though it is not clear that this step is necessary if the woman's HIV viral load is undetectable.

Women with HIV who become pregnant, regardless of the method, should seek prenatal care, right away, in a program with experts in preventing HIV transmission during pregnancy or at birth.

If you are a man with HIV and your female partner is HIV negative

In this situation, there is no "low-tech" method of conceiving that is 100% safe for the uninfected partner, and many couples prefer "high-tech" approaches. Options include:

• The man with HIV takes anti-HIV drugs and has an undetectable viral load; this minimizes the risk of infecting his partner. The couple then has sex without a condom, limited to the time the woman is ovulating (this reduces the number of times they have unprotected sex and thus lowers the risk of HIV transmission). In addition, the HIV-negative female partner may take HIV medications as prophylaxis to reduce her risk of infection with HIV, beginning in advance of attempts at conception and continuing afterward (this is called pre-exposure prophylaxis or PrEP), though it is not clear that this step is necessary if the man's HIV viral load is undetectable.
• Sperm washing with in vitro fertilization or intrauterine insemination may be considered. Sperm washing is intended to isolate individual sperm from the HIV virus in the semen. These methods require the assistance of a reproductive specialist or fertility clinic. For couples with different HIV status, these services are legal in some states, but not in all.

(See related question: Can two HIV-positive parents have an HIV-negative child?)