I want a baby, but I am scared of getting HIV

TOWARDS ZERO | HIV

Dear doctor,
I am HIV-negative, but my husband is HIV-positive and doing well on ARVs. I knew he was HIV-positive before we got married. Because I love him, I agreed to proceed with the relationship. We have been married for four years and would like to have a baby. We always use condoms when we have sex. Recently, he told me that we could try and have a baby, but I am so scared because it means I could easily get infected and probably give birth to an HIV-positive baby. Our families do not know what we are going through because we have not disclosed our predicament to them. Please advise.
Jackie

Answer

Dear Jackie,
Discordance, which you have described in the question above, is fairly common. Secondly, discordance is the basis of majority of new HIV infections. So we must deal with it firmly basing on scientific knowledge, which is now widely available. For example, we now know that people living with HIV (PLHIV) who are on ARVs and have undetectable viral loads are actually not very infectious. In short, "undetectable is equal to un transmittable". We also know that if HIV-negative people who are in discordant relationships are put on ARVs at a time of increased risk, such as when they have to have unprotected sex because they want to have a baby, the risk of them acquiring HIV is significantly reduced. So, instead of living in fear, learn the facts. Encourage your husband to take his ARVs with good adherence and when his viral load is undetectable discuss with your doctor who will arrange to put you on ARVs before you have unprotected during the time of your menstrual cycle when you can conceive. This is known as PrEP or pre-exposure prophylaxis. Using two or more methods as described above to prevent HIV transmission is known as combination prevention and it is more effective than depending on only one. Lastly, all people need to know this so that PLHIV or their HIV negative partners are not stigmatized isolated and made to live in fear and shame.