When both partners are HIV-positive

For couples in which both partners are HIV positive, some doctors still recommend safer sex to limit the possibility of reinfection with a different strain of HIV (or a resistant strain).

Reinfection is only a risk if one partner has extensive drug resistance and a detectable viral load, or neither partner is on ARVs. This should be the only reason that a couple should be discouraged to attempt to conceive naturally. Reinfection is even less likely if you only have unprotected sex a few times in order to conceive a baby.

Here are some other things to consider about the risk of reinfection:

• The risk will relate to viral load levels and be very low if you are on treatment.
• This consequence is only likely to be important if one partner has drug resistance, especially if they also have a high viral load.
• If you routinely practice safer sex, you may want to limit unprotected sex to the fertile period. You could also follow the advice for serodifferent couples.

For HIV positive couples who do not practice safer sex now, continuing to do so to conceive a baby will carry no additional risk.

All these options involve very personal decisions. Knowing and judging the level of risk is also very individual. All methods of becoming pregnant carry varying degrees of risk, and chance of success (and sperm washing and fertility treatment may involve a cost if you are unable to access them on the NHS).

If you are planning a pregnancy, take the time to talk about these options with your partner. This way you can make decisions that you both are happy with.