Either you or your partner has tested positive for HIV. Now you want to become pregnant. Is it an impossible dream?

Many people with the HIV virus are living longer and living healthier, and the number of deaths from AIDS has decreased. With a more hopeful future, it's no wonder that people with HIV are wondering about the possibility of pregnancy.

The decision to pursue parenthood is a complicated and difficult one for many people with HIV. High-tech procedures minimize the danger of passing the virus on to a partner or fetus. But no matter which technique is used to achieve pregnancy, there's a chance the child can become infected.

There are other factors to consider, as well. Will the HIV-positive parent live long enough to raise the child? Will the child's quality of life be compromised by the parent's illness? Can the parents designate a guardian? Parents who have HIV must have the courage to face tough decisions about the future, including their own mortality.

People with HIV who wish to conceive a child can start by doing the following:

  • Discussing options with a doctor
  • Talking to other couples who have been in the same situation, including parents of HIV-positive children
  • Exploring guardianship with family and friends

Conception techniques, risks, and possibilities differ according to which partner has HIV.

He's Positive, She's Negative

Conception when the male partner is HIV-positive is tricky, since logic dictates that he must use a condom to protect the female from becoming infected.

A relatively simple procedure called “sperm washing” may provide a low-risk conception option that involves artificial insemination with the male partner’s sperm. For years, this method has been used in sperm banks and infertility clinics to boost sperm potency. Scientists studying the technique have found that it lowers the level of HIV in the semen. The procedure is believed to be effective for reducing infection rates, but it does not completely eliminate the virus. Sperm washing for HIV-positive men is available in only in a limited number of countries, including Italy, the United Kingdom, Spain, and Switzerland.

The US Centers for Disease Control and Prevention (CDC) continues to investigate sperm washing. For now, its official stand is a warning that no evidence exists that any procedure can reliably remove all HIV from semen, and it recommends against artificial insemination with semen from HIV-positive men.

She's Positive, He's Negative

Doctors treat pregnant HIV-positive women with various medications, which have reduced mother-to-baby infection rates to approximately 2% under optimum conditions. Delivering via Cesarean section might lower the risk even more under certain circumstances. With current HIV treatment, though, it is not considered to offer as much of an advantage as it once did. There is additional protection by not breastfeeding, and treating the infant with medications after birth.

Factors contributing to the likelihood of a HIV-positive mother passing the infection to her child include the stage of HIV the mother is in, her viral load, if she's taking HIV medications, and how she has responded to medications.

When Both Prospective Parents Are Positive

People may believe that if both partners have HIV, then they needn't worry about infecting each other. Right? Wrong.

There are different strains of the virus, some of which are more aggressive. One parent may have one strain, and the other may have a different strain.

Some people with HIV choose unprotected intercourse for conception, despite the danger. Estimates of risk of partner infection for one act of unprotected vaginal sex vary widely, ranging from 1 in 500 to 1 in 5,000,000. According to the CDC, women are eight times more likely than men to become infected from a single act of intercourse. Infection from female to male occurs, although it's less common.

The numbers might look small, but the risk of fatal illness looms large. And, despite optimum conditions and the best medical interventions, the baby can become infected.

Difficult Decisions

If you or your partner has HIV, find out your risks and what you can do to minimize them.