Can You Have Children With HIV? Planning Safely for Baby and Partner

"If I have HIV, can I have children?" is a question full of hope and fear at the same time. I want to answer clearly from the start: yes, you can. Today, people with HIV, both women and men, can have healthy children who do not have HIV. What it takes is planning ahead with a doctor and taking treatment consistently.

Why it is safe to have children today

• U=U: when the partner with HIV takes treatment until their viral load is undetectable and stays that way, HIV is not passed on through sex. (Read U=U.)
• Prevention of mother-to-child transmission (PMTCT): when the mother takes medicine throughout pregnancy and the virus is undetectable near delivery, the chance of the baby being infected falls from about 15–45% in the past (without care) to below 1%.
• Thailand has done it: in 2016 the World Health Organization validated Thailand as the first country in Asia to eliminate mother-to-child transmission of HIV and syphilis.

For women with HIV

Before pregnancy

1. Take antiretroviral treatment until your viral load is undetectable before you start trying for a baby.
2. Discuss your regimen with your doctor. The WHO recommends dolutegravir-based regimens such as TLD for women planning pregnancy and for pregnant women.
3. Get tested for other infections that may affect the baby, such as syphilis and hepatitis B, and start folic acid in advance.

During pregnancy and birth

• Start antenatal care early, take your medicine every day without missing doses, and have viral load tests as scheduled, especially near delivery.
• If the virus is undetectable near delivery, most women can give birth vaginally according to obstetric indications. If the viral load is still high, the doctor may consider a caesarean section and give extra medicine during labour.
• Women who first learn they have HIV during pregnancy can still prevent transmission by starting treatment as soon as possible.

After the birth

• The baby receives a short course of antiretroviral medicine after birth, with the type and length depending on the risk, and HIV tests as scheduled during the first year.
• Breastfeeding: Thailand's guidelines still recommend formula feeding instead of breastfeeding, and the government provides formula for babies born to mothers with HIV. This is because U=U applies to sex and does not yet cover breastfeeding. Some countries are starting to allow mothers with very well-controlled virus to decide together with their doctor. Talk to the doctor caring for you before deciding.
• The mother must keep taking her medicine after the birth, because this is a time when many people miss doses through exhaustion.

For men with HIV whose partner does not have HIV

• If the man has had an undetectable viral load continuously for at least 6 months, confirmed by viral load results, the couple can conceive naturally without passing on HIV, according to U=U.
• If the virus is not yet controlled, or the couple wants extra reassurance, the woman can use PrEP while trying to conceive, as assessed by a doctor.
• Other options, such as sperm washing with insemination or IVF, are used in some cases, for example when the virus is still detectable or there is also a fertility problem.
• If you have been trying without success, a semen test is worth considering. (Read Semen analysis.)

Couples where both partners have HIV, or the woman has HIV and the man does not

The principle is the same: the partner with HIV takes treatment until undetectable before starting to try for a baby. If the woman has HIV and the man does not, once she keeps her virus controlled, sex around ovulation does not pass HIV to him, and there is also the option of self-insemination of his semen into the vagina around ovulation. For couples where both have HIV, both should keep their virus controlled, for the health of both parents and the baby.

While you are not yet ready for a baby

If you do not want a pregnancy yet, use contraception as well. Dolutegravir-based regimens can generally be used with hormonal contraception, but some antiretroviral regimens (such as efavirenz) reduce the effectiveness of contraceptive implants, so always tell your doctor which contraception you use. Condoms also help prevent other sexually transmitted infections, and it is worth getting tested together as a couple before planning a baby.

Let me help you plan your family

At Dr. Kris Clinic in Surat Thani, I provide family medicine care, from counseling couples with different HIV status, reviewing viral load results and testing for sexually transmitted infections before pregnancy, to providing PrEP for the HIV-negative partner and coordinating referral to an obstetrician and the right hospital once you are pregnant. You are welcome to come as a couple, at the clinic or online, and English-speaking consultations are available.