Having Children When You Have HIV – Still a Problem?

by Dr. Ann Boyer

When I began working with HIV in the 1980s, women still had a 9 to 30 percent chance of passing it to their babies (depending on whether or not they were adequately treated with AZT). And after they had a child, arrangements needed to be made to assure that continuity of love and care for the infant if, and more likely when, the mother died of HIV-related causes.  

Obstacles abounded.  Doctors declined treatment.  Discussions raged about the ethics of women bearing children if they were found to have the HIV virus, and, whether women were immoral to decline testing. Hidden issues of race and class infiltrated people’s attitudes.. (A 1988 On The Issues Magazine carried an article by Barbara Santee, “Women, AIDS and Choice” that described vividly many of the debates around women and HIV.)

Well, we have come a far distance from there. With the advent of more potent antiretrovirals with less side effects and once or twice daily dosing of only a few pills, the probability of mother-to-infant transmission in a woman who is receiving medical care is close to zero.  If the mother continues in care, she may lead a very normal life and see her children grow to adulthood – as with any other chronic disease.

There are still some providers, however, who believe that an HIV+ diagnosis will inevitably lead to a shortened life and are opposed to HIV+ women having children.

Therefore, any HIV+ woman who is considering pregnancy should discuss it with her provider. If the provider is less than supportive – stick to your guns, don’t be dissuaded – and seek a second opinion from an Ob-Gyn who has experience with HIV (when a woman is actually pregnant, she is no longer cared for by her primary care doc, but by an Obstetrician until she delivers). Just call any medical center, ask for the Obstetrics department and request a referral to someone who specializes in ‘high risk pregnancy’ (not that having an HIV diagnosis, per se, makes a woman ‘high risk’ – but it did in the past).

Getting Pregnant for the HIV+

In terms of the “mechanics” of conception in the presence of HIV in one or both partners, there are several practices that work well:

If a woman is negative, but her partner is +, they can get “washed” sperm, so they become pregnant without the threat of the woman becoming infected with HIV.

If a woman is HIV+, but her partner is not, the “turkey baster” approach works beautifully (I, personally, have coached three clients who now have children.) This method is a home-grown version of artificial insemination: a woman keeps track of her temperature and establishes when ovulation is imminent, her partner ejaculates into a sterile container; the ejaculate is drawn up into a turkey baster which is then gently inserted into the vagina of the woman lying on her back, and the semen is allowed to flow over the cervix.

If they are both HIV+, some combination of the two approaches will work.

The need for such precautions in the presence of well-controlled HIV with undetectable Viral Loads for 2 years or more is unclear. We know that the chances of sexual transmission of HIV under those circumstances are extremely low. I would not be surprised if a growing number of couples in that category are creating their families in traditional ways.

Dr. Ann Boyer began in Ob-Gyn, expanded to women’s health and then into HIV and substance use.  She is currently on the faculty at Mt. Sinai Medical Center and Medical Director of Concourse Medical Center, a methadone and drug treatment program, where she treats HIV/Hepatitis C and is creating a program for pregnant and parenting women.


The Café