Can an HIV positive man still have children?
Can an HIV positive man still have children? If so, what is the risk to mother and child?
Thanks for your question which is quite complicated to answer.
Firstly, the risk of a baby having HIV is only directly related to the HIV status of the mother, not the father.
Many HIV positive women are having healthy HIV negative babies by using combination therapy (ARV’s) during pregnancy. This reduces the risk of transmission to the baby to less than 1%, if the mother’s viral load is undetectable when the baby is born.
So if your partner is also HIV positive, this is how you can have an HIV-negative baby.
However, if your partner is HIV negative, then what you are asking about how your partner can become pregnant without the risk of catching HIV.
Some specialist HIV clinics have assisted conception units where sperm can be treated (basically by being spun to separate the sperm (which doesn’t contain HIV) from the liquid in the semen (which does contain HIV). This process is called sperm-washing, and it is 100% safe for the woman in terms of protection from HIV, although the final conception rate is only 15-18%.
A more controversial option, is for an HIV positive man to use HIV treatment to reduce his viral load to undetectable both in blood and semen, and then to use limited conception attempts at the most fertile days in the woman’s cycle. Conception can either be naturally (having gentle sex) or using self insemination. Most doctors can provide guidance on how to plan and identify which days would be appropriate.
Viral load in semen can be tested using the same viral load tests that are used for blood, and your hospital could advise on this. The additional safety from testing semen viral load is that approximately 10% of people with undetectable levels in blood, can have detectable levels in semen.
Artificial or self-insemination would reduce the risk of trauma during sex where a small tear could increase the risk of HIV transmission.
Continuing to use condoms at all other times is essential.
This is more controversial because there is a small risk of transmitting HIV. However, especially where sperm-washing is not available, there have been encouraging reports that this has been successful (in one report around 60 couples conceived without any HIV transmission). For many women who want to have children, this risk may be acceptable, but it can only be something that the woman decides freely.
If you are trying this, there may be an additional safety benefit from using 1-2 days of HIV-drugs to reduce the slight chance of infection even futher. Several studies are looking at whether using tenofovir and FTC (or 3TC) before exposure to HIV can be proctective. This is based on optimistic animal studies.
In this respect, some healthcare providers may be able to help with information and counselling, and others may be openly hostile to this approach.
The i-Base guide to HIV, Pregnancy and Women’s Health includes a chapter on planning pregnancies and is available online or in print.