HIV and women – having children

HIV is a virus that can weaken the immune system to the point where it is unable to control some infections. HIV infection is not the same thing as AIDS. AIDS (acquired immune deficiency syndrome) occurs when HIV causes significant damage to the immune system. HIV is now very treatable, which means that with effective treatment, AIDS has become rare.

HIV treatment and an undetectable viral load#

HIV treatments (sometimes called antiretrovirals or ART) suppress HIV in the blood to very low levels. When standard blood tests can no longer detect the virus, this is known as being ‘undetectable’. Most people who take their HIV treatment as prescribed can expect an undetectable viral load, and they can live long and healthy lives without developing AIDS.

When HIV is undetectable, it cannot be passed on through sex. This is sometimes described as U=U (undetectable = untransmittable). It is also safe to become pregnant and breastfeed without fear of passing the virus on to the baby.

How HIV spreads#

HIV is transmitted through:

• anal or vaginal sex without condoms, when other prevention methods such as PrEP or an undetectable viral load are not in place
• sharing needles, syringes and other injecting equipment

People on antiretroviral treatment who achieve and maintain an undetectable viral load cannot pass on HIV sexually. For people who do not have HIV, the regular use of condoms is the easiest way to prevent it. PrEP (pre-exposure prophylaxis) is a medication that, when taken as prescribed, prevents HIV infection.

HIV and family planning#

Deciding to have a baby is a big decision for anyone. With effective treatment and good care, women with HIV can feel safer about having children and can plan for a safe and healthy pregnancy.

To reduce the chance of HIV passing from mother to child, the best situation is when:

• viral load tests show you have had a consistently undetectable viral load for at least the previous 6 months
• you have regular, ongoing contact with a clinical care team

Several studies show that when these conditions are in place, HIV transmission from mother to baby does not occur.

Getting support early#

If you have HIV, or have a partner with HIV, it is important to seek support early so you can get the best treatment and care. It may help to talk things through with:

• your treating doctor or a family planning specialist
• a clinic that provides expert advice about HIV in pregnancy and assisted reproductive technology options for serodiscordant couples (where one partner has HIV and the other does not)
• a counsellor who specializes in this area
• a peer support worker — someone living with HIV who can share their insights, often including their own experience of planning and raising a family

It is common for women with HIV to have concerns about pregnancy, childbirth or breastfeeding. An HIV clinician, counsellor or peer support worker can help reassure you and weigh up your options. They can become part of your care team when you are planning for or having children, and all conversations are private and confidential.

HIV treatment and pregnancy#

Make an appointment with a doctor to talk about your treatment, as some women may need small treatment changes. Pregnancy can be safe for a mother with HIV and her baby when strategies to reduce transmission are in place. These include:

• taking antiretroviral medication before conception to lower your viral load (the amount of virus in your body fluids) — the lower the viral load, the lower the risk of transmission to your unborn baby
• starting HIV treatment as soon as you are diagnosed, which also helps your overall health

Being on effective treatment with a low or undetectable viral load improves your immune system and health throughout pregnancy. With specialized care, pregnancy for a mother with HIV today is much the same as for a mother without HIV, and pregnancy does not make HIV progress any faster.

Childbirth and HIV#

Women who have HIV and are under the care of an HIV specialist and obstetrician can give birth vaginally or by caesarean section. Your care team can help you make a birthing plan that is right for you.

Baby feeding and HIV#

With effective treatment and clinical support, breastfeeding is a safe option for women with HIV whose viral load is undetectable. Some women — for example, those who are not on HIV treatment — may be advised that formula feeding is safer. Discuss baby feeding with your health care team so you can choose the option that is best for you.

Treatment for babies of mothers with HIV#

Babies whose mothers have HIV receive antiretroviral treatment for a period of about 2 to 6 weeks after birth, which significantly reduces their chance of getting HIV. The type and duration of treatment depends on the mother’s viral load and the risk of transmission to the newborn. For mothers with an undetectable viral load at the time of delivery — now the most common situation — newborns usually need only about 2 weeks of treatment.

Babies are also tested regularly for HIV, usually until they are about 18 months old, using a combination of antibody and PCR (polymerase chain reaction) tests. It is important that babies exposed to antiretroviral medication continue to be monitored. Babies who are not breastfed are generally considered HIV negative by about 3 months of age, and it is rare for a baby to test positive.

Medical care for babies with HIV is specialized, and you can expect welcoming, non-judgemental and compassionate care for yourself and your baby. With early diagnosis, babies can start effective treatment and have every chance of a long, healthy life.

Key points#

• HIV treatments (antiretrovirals, or ART) suppress HIV in the blood to very low levels.
• Most people who take their treatment as prescribed can expect an undetectable viral load.
• People with an undetectable viral load cannot pass on HIV sexually (U=U).
• With effective treatment, women with HIV can have a safe pregnancy and, when their viral load is undetectable, can breastfeed.
• Babies of mothers with HIV receive a short course of antiretroviral treatment and are tested regularly; it is rare for them to test positive.

Where to get help#