by J. Edward Casteele

Created on: June 28, 2009   Last Updated: July 04, 2009

The decision to start a family is a big one, as having a child changes almost every aspect of your life. If you, your partner, or both of you are HIV positive, however, the decision can be even more difficult to make. Many individuals and couples feel that they have to weigh their desire to have a baby against the possibility of passing HIV on to their child; some even feel that it is not possible to safely have a child because of this risk. Modern HIV treatment has largely removed this risk, allowing individual to make the decision to safely have a baby even when they or their partner are HIV positive.

Even in cases where both the father and mother are HIV positive, it is quite possible to have an HIV negative baby. With proper prenatal care and medication, the chances of passing HIV to a baby during gestation and birth are less than 2%. The exact method of infection prevention depends largely upon whether both partners are HIV positive or if only the male or female partner is; in cases where only one partner is positive, different steps must be taken in order to not only avoid infecting the baby, but also the negative partner.

If the male partner is HIV positive, a process known as "sperm washing" or "semen washing" is used to separate the man's sperm from his seminal fluid. This allows the sperm to be used for en vitro fertilization and protects not only the child from infection, but also prevents infection or reinfection of the female partner. If the female partner is HIV negative, there is no risk to her or the child and no antiretroviral (ARV) treatment is necessary during the course of the pregnancy.

Should the female partner be HIV positive, a different method must be used to protect the unborn baby against infection. ARV treatments are generally administered during the pregnancy to keep the mother's virus load low and to keep her healthy. An intravenous drip may be used during delivery to help prevent infection, or Cesarean birth may be used as an alternative to natural delivery in an attempt to reduce the risk of infection during the birthing process. If the male partner is HIV negative, artificial insemination techniques can be used to achieve pregnancy with no risk to the man (even though the risk of female-to-male transmission is significantly lower than male-to-female during sex, artificial insemination can remove the risk entirely.)

When the child of an HIV-positive woman is born it will at first test positive for HIV antibodies, but this does not mean that the baby has HIV. AZT will be given to the child in a syrup form for the first six weeks of its life, after which time it will be tested again and will most likely test negative. In order to prevent accidental infection after birth, breast feeding should be avoided, as breast milk can also transmit HIV.

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