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FAQ: Can a mixed HIV status couple conceive a baby without infecting the uninfected person?

for Veterans and the Public

Frequently Asked Questions

Q: Can a couple in which one person is HIV positive conceive a baby without the uninfected partner becoming infected?

Many couples in which one person is HIV positive and the other person isn't want to have children and, fortunately, with some careful planning, it usually is possible to have a safe and successful pregnancy while preventing HIV from passing to the HIV-negative partner (or to the baby). It is very important to discuss your desires and intentions for childbearing with your health care provider before the woman becomes pregnant. Your provider can help with decisions about how to conceive safely (if your provider is not familiar with reproductive issues for HIV-positive persons, ask to see an HIV specialist). That will help to ensure the woman (if she is HIV infected) is on HIV medications (ARVs) that are effective and appropriate for pregnancy. Also, her provider can advise her on other important ways to protect her health before pregnancy.

If you are an HIV-positive woman and your male partner is HIV negative

There are "low-tech" and "high-tech" approaches. A safe and "low-tech" method is to do home insemination using your partner's semen and a needleless syringe, timed with your ovulation. By this method, your partner has no possible exposure to HIV. A more "high-tech" version of this approach is to use either intracervical or intrauterine insemination. For this, you would need the assistance of a fertility clinic.

Fancier approaches are not really needed in this situation (unless you and your partner have fertility problems), but you could seek advice and assistance at a fertility clinic or an HIV clinic with experience in preventing mother-to-child transmission of HIV. They may offer insemination services (these services are legal in some states for couples with one HIV-positive partner, but not in all states).

Approaches that involve unpretected sex between the partners are riskier as far as HIV transmission is concerned. Some strategies significantly reduce the likelihood of infection but are not 100% reliable; transmission sometimes (though rarely) may occur. The following approach can be considered, though it has not been studied thoroughly in the context of trying to conceive a baby, and currently it is not recommended by VA guidelines.

  • The HIV-positive woman takes anti-HIV drugs and has an undetectable viral load; this greatly reduces the risk of infecting her partner. The HIV-negative male partner takes HIV medications as prophylaxis to reduce his risk of infection with HIV, beginning in advance of attempts at conception and continuing afterward (this is called pre-exposure prophylaxis or PrEP). The couple then has unprotected sex limited to the time the woman is ovulating (this reduces the number of times they have unprotected sex and thus lowers the risk of HIV transmission).

HIV-positive women who become pregnant, regardless of the method, should seek prenatal care, as early in the pregnancy as possible, in a program with experts in preventing HIV transmission during pregnancy or at birth.

If you are an HIV-positive man and your female partner is HIV negative

There are "low-tech" and "high-tech" approaches, but unlike the reverse scenario, in which the woman is HIV positive, in this situation, there is no "low-tech" method of conceiving that is 100% safe for the uninfected partner, and many couples prefer "high-tech" approaches. Options include:

  • The HIV-positive man takes anti-HIV drugs and has an undetectable viral load; this greatly reduces the risk of infecting his partner. The HIV-negative female partner takes HIV medications as prophylaxis to reduce her risk of infection with HIV, beginning in advance of attempts at conception and continuing afterward (this is called pre-exposure prophylaxis or PrEP). The couple then has unprotected sex limited to the time the woman is ovulating (this reduces the number of times they have unprotected sex and thus lowers the risk of HIV transmission).
  • Sperm washing, which is intended to isolate individual sperm from the HIV virus in the semen, in combination with in-vitro fertilization or intrauterine insemination. These methods would involve the assistance of a reproductive specialist or fertility clinic. For HIV-discordant couples, these services are legal in some states, but not in all.

(See related question: Can two HIV-positive parents have an HIV-negative child?)