HIV and women – having children
HIV and women – having children
What is HIV?
HIV is a virus
that can weaken the immune system to the point that it is unable to control some infections.
HIV infection is not the same thing as AIDS. AIDS (acquired immune deficiency syndrome) occurs when HIV causes significant damage to the
immune system
leaving a person vulnerable to illness and
infections
.
HIV is now very treatable, meaning AIDS is very rare in Australia.
HIV treatments (sometimes called antiretrovirals or ART) suppress HIV in the blood to very low levels. When standard blood tests cannot detect HIV (known as being ‘undetectable’ or U=U).
Most people who take their HIV treatment as prescribed, can expect an ‘undetectable’ viral load. They will also live long and healthy lives without developing AIDS.
When HIV is undetectable, it cannot spread through sex. It is safe to become pregnant and breastfeed without fear of passing the virus on to the baby.
How HIV spreads
In Australia, HIV is transmitted through:
Anal or vaginal sex without the use of
condoms
.
Having unprotected sex with someone with HIV without using other prevention methods – like PrEP (an HIV prevention drug) or ‘undetectable viral load’ (when a person with HIV has very low levels of the virus in their body) known as U=U or undetectable = untransmittable.
Sharing needles, syringes and other injecting equipment.
People on antiretroviral treatment (ART) who achieve and maintain an undetectable viral load cannot spread HIV sexually.
For people who do not have HIV, regular use of condoms is the easiest way to prevent HIV.
For those at higher risk of HIV,
PrEP (pre-exposure prophylaxis)
is a medication that, when taken as prescribed, prevents HIV infection.
HIV during pregnancy and childbirth
In Australia, effective treatment and quality care help women with HIV to feel safer having babies and
breastfeeding
.
To prevent HIV passing from mother to child, ’the optimal scenario’ is when these factors are present:
HIV antiviral treatment
viral load tests show that you have had a consistently undetectable viral load for the previous 6 months or longer
regular ongoing contact with a clinical care team.
Several studies show when these conditions are in place, HIV transmission from mother to baby does not occur.
World Health Organisation
(WHO)
External Link
supports breastfeeding where HIV is below detectable levels.
Australian clinical guidelines support women with HIV to have open discussions about their options (such as
natural conception
and breastfeeding).
If women are not taking HIV treatments, or do not have an undetectable viral load, formula feeding is the safe option.
HIV and family planning
Deciding to have a baby is a big decision
. For a woman who has HIV (or has a partner with HIV), it is important to seek support early to get the best treatment and care to ensure you have a
safe and healthy pregnancy and baby
.
It may help to talk issues through with:
Your treating doctor.
HIV specialist,
obstetrician
or family planning specialist.
Reproductive Services at Melbourne’s Royal Women’s
Hospital
External Link
– (by GP referral). Clinic staff can provide expert advice about HIV in pregnancy and assisted reproductive technology options for serodiscordant couples (couples where one partner has HIV and the other does not).
A counsellor who specialises in this area.
A peer support worker – is someone living with HIV who can share their insights to help you understand what your experience might be and what to expect. Many peer support workers have lived experience planning and raising their own family.
Concerns women with HIV may have
It is common for women with HIV to have concerns about pregnancy, childbirth or breastfeeding.
An HIV clinician, counsellor or peer support worker can help to reassure you by providing advice to weigh up your options. These workers can become part of your care strategy when planning for or having children.
All conversations you have with them are private and confidential during this process.
See the ’where to get help’ section for more information.
Telling health professionals about your HIV status
Tell your doctor, obstetrician or
midwife
about your HIV status when planning to have a baby.
You can to talk through any concerns and ensure treatment suits your needs before, during and after your pregnancy.
Testing positive for HIV during pregnancy
HIV testing is often undertaken as part of sexual health screening or
testing in early pregnancy
(antenatal testing).
Receiving an HIV diagnosis during pregnancy can be a shocking and distressing experience.
It is important for women in this situation, to get immediate referral to clinicians knowledgeable about HIV and to other support services (including peer support).
Support is available through:
Positive Women Victoria (peer
support)
External Link
Victorian HIV Service, Alfred
Hospital
External Link
Royal Women’s
Hospital
External Link
.
HIV pregnancy services in Victoria
If you have HIV and become pregnant, or would like to have a baby, see a specialist HIV service to discuss your options.
Victorians can access the following services:
Victorian HIV Service, Alfred Hospital (no referral is necessary).
Reproductive Services Clinic, Royal Women’s Hospital (by doctor referral) – doctors specialise in HIV and reproductive health. Assists couples of different serostatus where one partner has HIV and the other does not) to conceive safely.
When a partner with HIV has an undetectable viral load, there is zero risk of transmitting HIV to the partner without HIV. This makes it easier for discordant couples to conceive naturally.
HIV treatment and pregnancy
Not all HIV antiretroviral (ART) medications are safe during pregnancy. Some women may need some small treatment changes. Make an appointment with a doctor to talk about your treatment.
Pregnancy can be safe for a mother with HIV and her baby when HIV transmission reduction strategies are in place.
Reducing HIV transmission risk during pregnancy
For women with HIV, ways to reduce the risk of transmission include:
Taking antiretroviral (ART) medications before conception to reduce your viral load (the amount of virus in the fluids in your body). The lower the viral load, the lower the risk of transmission to your unborn baby.
Starting antiretroviral HIV treatment as soon as diagnosis (this will also help to optimise your overall health).
Being on effective treatment and having a low, or undetectable, viral load improves your immune system and health throughout pregnancy.
With specialised care, pregnancy for a mother with HIV today is the same as pregnancy for mothers without HIV.
Pregnancy does not make HIV progress any faster.
Childbirth and HIV
In Australia, women who have HIV and are under the care of an HIV specialist and obstetrician, can give birth vaginally or by
caesarean section.
Birthing plan options
are based on women’s individual health needs.
Baby feeding and HIV
With effective treatment and clinical support, breastfeeding is a safe option for women with HIV.
Some women with HIV may be advised that formula feeding is safer (such as women who are not on HIV treatment).
Formula feeding is an option that may be chosen by or recommended to some women with HIV.
Discuss baby feeding issues with your health care team. Guidance on infant feeding is available from the
Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine
(ASHM)
External Link
.
Prevention treatment for babies of mothers with HIV
Babies whose mothers have HIV receive antiretroviral treatment (ART) for a 2 to 6-week period after birth. This treatment is known as
PEP (or post-exposure prophylaxis)
, and significantly decreases their chance of getting HIV.
Treatment type and duration depends on a mother’s viral load and risk of transmission to her newborn. For mothers with an undetectable viral load at the time of delivery (the most common scenario in 2023), newborns only need 2 weeks treatment.
Babies will also be regularly tested for HIV, usually until they are 18 months old. Testing involves a combination of antibody and PCR (polymerase chain reaction) tests.
It is important that babies exposed to antiretroviral medication continue to be monitored. They are generally considered HIV negative by 3 months of age if they are not breastfed.
Babies born to women with HIV in Victoria are referred to specialised paediatric support – usually to the Royal Children’s Hospital or Monash Children’s Hospital.
Babies with HIV
It is rare for babies to test positive for HIV. Many professionals and organisations are available to help you during this difficult time.
You can expect welcoming, non-judgemental and compassionate care for yourself and your baby. Medical care for babies with HIV is specialised.
With early diagnosis, babies can start effective treatment and have every chance for a long, healthy life.
Where to get help
Your GP (doctor)
Your local community health service
Melbourne Sexual Health
Centre
External Link
Tel.
(03) 9341 6200
or
1800 032 017
or TTY (for the hearing impaired)
(03) 9347 8619
Get
PEP
External Link
If you believe you may have been exposed to HIV. Tel.
1800 889 887
Living Positive
Victoria
External Link
Tel.
(03) 9863 8733
Positive Women
Victoria
External Link
Tel.
(03) 9863 8747
HIV Outward Program, HIV Service, Alfred
Health
External Link
Tel.
(03) 9076 5436
Positive Living
Centre
External Link
Tel. (03) 9863 0444 or
1800 622 795
(for country callers)
Multicultural Health and Support
Service
External Link
, Centre for Culture, Ethnicity and Health Tel.
(03) 9418 9929
Thorne Harbour
Health
External Link
(formerly Victorian AIDS Council) Tel.
(03) 9865 6700
or
1800 134 840
Equinox Gender Diverse Health
Centre
External Link
Tel.
(03) 9416 2889
PRONTO!
External Link
Tel.
(03) 9416 2889
Sexual Health
Victoria
External Link
– comprehensive sexual and reproductive health services for people of all ages. Tel.
1800 013 952
or
(03) 9257 0100
Ballarat Community Health Sexual Health
Clinic
External Link
Tel.
(03) 5338 4500
Bendigo Community Health Sexual Health
Clinic
External Link
Tel.
(03) 5434 4300
Or
(03) 5448 1600
Gateway Health
Clinic
External Link
, Wodonga Tel.
(02) 6022 8888
or
1800 657 573
Sunraysia Community Health
Services
External Link
Tel.
(03) 5022 5444
Barwon Health Sexual Health
Clinic
External Link
Tel.
(03) 5226 7489
Victorian Aboriginal Health
Service
External Link
Tel:
(03) 9419 3000
1800MyOptions
External Link
Tel:
1800 696 784
is a statewide phone service for information about sexual health as well as contraception and pregnancy options
Sexual Health Victoria
(SHV)
External Link
. To book an appointment call SHV Melbourne CBD Clinic:
(03) 9660 4700
or call SHV Box Hill Clinic:
(03) 9257 0100
or (free call):
1800 013 952
. These services are youth friendly.
Women’s sexual and reproductive health hubs
(throughout Victoria)