Relationship with HIV positive man — Can I have kids?

Dear Reader,

Kudos to you and your boyfriend for taking some valuable steps in building a trusting and healthy relationship! Talking about HIV status can be a sensitive and daunting task — especially with someone you care about deeply. While HIV status may influence how or when you decide to have kids, it does not mean you can never have children. There are many ways for couples and individuals to choose to become parents — adoption, artificial insemination, conception via sexual intercourse, surrogacy, and so on. When one or both partners are HIV+, talking with a health care provider who is well versed in HIV care and family planning might help you talk through options to find what’s right for you and your partner. Below are some possible options for you both to consider, depending on your circumstances.

• If you’re an HIV-negative biological female, you may consider:
  • Pre-exposure prophylaxis (PrEP) — Use of this prior to conception can greatly reduce your risk of contracting HIV (if you are currently HIV negative and having oral, anal, or vaginal sex with your boyfriend). PrEP is the procedure of taking anti-retroviral medications, if you’re HIV-negative, in order to prevent you from acquiring the disease. There is ongoing research being conducted about using PrEP to prevention transmission while attempting to conceive. In one study, among heterosexual couples with an HIV negative female partner, the use of PrEP during attempted conception was evaluated. No females in the study became HIV positive and pregnancy rates were high. Research is ongoing to evaluate whether the use of PrEP is safe to also use during pregnancy and lactation to prevent transmission to the baby.
  • Spermwashing — If you’d like your HIV positive boyfriend to be the biological father, one option for conception is spermwashing. This involves removing the seminal fluid surrounding a sperm, and then implanting that sperm in one of your eggs. HIV is carried by seminal fluid, but not by the sperm itself. Recent research shows spermwashing to be safe, if done by qualified medical personnel. Spermwashing is approved by the World Health Organization, however, the U.S. Centers for Disease Control and Prevention (CDC) recommend against it as an option due to at least one documented case in which a female partner became infected with HIV via spermwashing.
  • Semen analysis — Your partner may be advised to get a semen analysis before you try to conceive. If he has semen abnormalities, you may have a lower likelihood of getting pregnant. If you know that it’s unlikely that you can be pregnant using his sperm, you may choose to avoid unnecessary exposure to HIV.
  • Conception with an HIV-negative sperm donor or sexual partner via sexual intercourse or artificial insemination — Sperm banks test all donor sperm for HIV.

• If you’re an HIV-positive biological female, you may consider:
  • Beginning or continuing antiretroviral drugs (ARVs) — You may already be taking ARVs. If you are, your health care provider can tell you if the ARVs you’re using right now would be safe during pregnancy. Your provider may also make adjustments if you are trying to conceive. If you’re not on ARV drugs, and you do become pregnant, you can start taking them at the beginning of the second trimester of pregnancy. If you are unable to do that, these drugs can also be administered during labor and delivery.
  • Caesarian delivery — Many HIV and family planning experts recommended that you deliver via Caesarian section (C-section) to reduce likelihood of HIV transmission during childbirth.
  • Choosing an alternative to breastfeeding — Breast milk is one way that HIV can be transmitted, so breastfeeding is not advised if there is a risk of transmission. Formula feeding can be an alternative to breastfeeding.
  • A combination of all three — Combining ARV, C-section, and formula-feeding can reduce the risk of transmitting HIV to the baby to below two percent.

• If you are a biological male (cis- or male-to-female transgender), or have a condition which would prevent you from carrying a child to term, you could choose a surrogate mother. With spermwashing, even if the biological father is HIV positive, HIV negative surrogate mothers have carried HIV negative children to term at little risk of infection to the mother or child.

• No matter what your circumstances, you may also consider adoption. Some things to keep in mind when considering adoption as a couple with a HIV positive parent:
  • The Americans with Disabilities Act makes it illegal for adoption agencies to discriminate against potential parents because they are HIV positive. Consider asking your health care provider for help locating an adoption agency.
  • Adoption agencies outside of the United States may have no such laws. If you try to adopt from abroad, you may end up being rejected because of an HIV positive diagnosis.
  • If you’re a same-sex couple, you may face a similar problem — Same-sex parent adoption is illegal in many countries, as well as some states in the U.S..
  • One way to hopefully avoid these examples of discrimination is to seek out adoption agencies that specialize in HIV positive and LGBTQ parenting. You may be able to find resources at your local LGBTQ community center. You can also find information from the Human Rights Campaign.  

 Here are some additional considerations for HIV+ individuals and family planning:

• Genital tract infections — Whether or not you’re HIV+, HIV health care providers recommend screening and treatment for genital tract infections before you attempt to conceive. Genital tract infections can increase the reproduction of HIV in genital areas. Sometimes, HIV isn’t detectable in a person’s bloodstream, but is detectable in their genital tract.
• Viral suppression — Before attempting to conceive, your boyfriend may be advised to take steps to suppress (or lower) his viral load as much as possible. Note: even if your boyfriend is at maximum suppression, there is still a chance that he could transmit the HIV virus to you if you’re having vaginal, oral, or anal sex.

Couples HIV testing and counseling is recommended and will likely help guide and support your family planning decision making. This service involves discussing your test results with a supportive professional. In turn, they can recommend treatment, support, and prevention of transmission of the disease, if you are HIV negative.

Lastly, it’s wonderful that you are choosing to use protection together. You may already be aware that condoms and other barrier use can greatly reduce the likelihood of HIV transmission. However, no form of protection is completely failsafe. Consider making an appointment with your health care provider if you would like to talk about your specific health concerns.