If you’re living with HIV and are thinking about having kids – you can. With the right care and medication, people living with HIV can have healthy pregnancies and children, without transmitting HIV to a partner or child.
“We’ve come to a place where we have really wonderful medications and medical advances that advocates of the past have fought hard to get us,” says Monica Hahn, MD, an HIV specialist and associate clinical professor of family and community medicine at UCSF School of Medicine.
“Now if you can consistently take your medicines, you can have essentially a normal and healthy pregnancy, delivery, and baby – a baby free of HIV,” she says. “We can essentially guarantee that.”
If you’re planning to get pregnant and you and/or your partner have HIV, talk with your HIV doctor to make sure your treatment is on track. And if you do get pregnant, tell your HIV doctor right away. This is part of making sure that you and your baby will be healthy.
Undetectable Equals Untransmittable
If you have a partner without HIV, conceiving without fear of transmitting HIV used to be complicated, often requiring intrauterine insemination and fertility treatments.
Today, HIV experts follow a concept called “U=U,” which stands for “undetectable equals untransmittable.” That means that if you maintain an undetectable viral load, you won’t transmit HIV through sex.
Having an undetectable viral load means there is very little HIV in your blood. Taking your antiretroviral medication every day makes your viral load undetectable.
“This is really a breakthrough discovery and a wonderful, freeing advancement, knowing that people living with HIV can and should have healthy and enjoyable sex lives and family-building opportunities that they and all people deserve,” Hahn says.
“We know that people living with HIV can absolutely have healthy pregnancies and children free of HIV without the use of any special technologies aside from staying on their HIV medicines,” Hahn continues. “The great news that I tell the patients I care for now is really quite different from what we were saying 10 years ago.”
U=U also applies to transmitting HIV from a pregnant person to their baby – if they have a consistent undetectable viral load before conceiving, throughout pregnancy, and at delivery, says Judy Levison, MD, a professor of obstetrics and gynecology at Baylor College of Medicine who specializes in HIV and pregnancy. In those circumstances, “there have been zero cases of transmission to babies,” she says.
Getting Pregnant with a Partner
If you are living with HIV and want to get pregnant, the first step is to take your antiretroviral medication regularly and reach an undetectable viral load. (You need to be doing this for your own health, and if you're considering conceiving, you’re also doing it to protect your baby.) Keep an undetectable viral load for 3-6 months, and then you can have sex without a condom without risk of transmitting HIV to your partner, Levison says.
If you have HIV and want to get your partner pregnant with your sperm, the advice is the same: Take your medication and achieve a consistent undetectable viral load, and then go ahead and try to conceive.
If you don’t have HIV but your partner does, ask your doctor if preexposure prophylaxis (PrEP) is an option. PrEP is a daily pill that lowers the odds of getting HIV. PrEP is safe to take during pregnancy and breastfeeding.
Planning for Pregnancy and Birth
Many HIV medications are safe to take during pregnancy, so you will likely be able to stay on your same medicine while pregnant. You should have your viral load checked often – every month or two – to make sure it stays undetectable. Sometimes, medication works differently during pregnancy, so your doctor may need to adjust your drug or dose if your viral load rises.
Labor and delivery for people living with HIV is about the same as for those without it, Hahn says. You’ll be able to have a vaginal birth as long as your viral load is under 1,000 when you’re ready to deliver. If it’s over 1,000, you’ll need a C-section in order to reduce the risk of the baby getting HIV during the birth.
After birth, your baby should get 4 weeks of AZT medication, which protects them against HIV. They’ll be tested several times: at birth, 2 weeks, 4 weeks, and 4 months, Hahn says.
Breastfeeding has historically not been recommended for people living with HIV – and that’s still the official recommendation in the U.S., as it has been since 1985.
But many parents want to breastfeed, Levison says. A panel of experts has advised the U.S. Department of Health and Human Services (HHS) about this. The panel affirmed that breastfeeding isn’t recommended for people with HIV because the risk isn’t zero. But the panel recommended that if a doctor has a patient with HIV who wants to breastfeed, they should talk with them about the risks and benefits.
“We can’t say U equals U for breastfeeding, but we can say the risk is very low [for people who have undetectable viral loads],” Levison says. If you decide to breastfeed, she says you need to take your medications, have your viral load monitored every 1-2 months, and have your baby tested regularly.
“We just have to say we cannot give you a 100% guarantee that you won’t transmit” HIV to your baby through breastfeeding, Levison says. “And then they need to make the decision that’s right for them.”
More Ways to Have a Family
People living with HIV can use any kind of fertility treatment, such as in vitro fertilization (IVF) and egg freezing. Sperm used in fertility treatments is routinely “washed” before it’s used. That process removes HIV from the semen.
Fertility clinics can also help you build your family through methods like donor insemination or gestational surrogates if needed.
Adoption is also an option. It’s illegal for adoption agencies to discriminate against people living with HIV under the Americans with Disabilities Act.