One young woman was 21, married a year and, along with her husband, was thrilled to be pregnant. Another was a 33 year old mother of two who had remarried and was now pregnant with what would be her husband’s first child. The third woman was a high school student who had not planned to get pregnant, but thankfully had family support and planned to keep her baby and finish her studies.
What do these three women have in common? They all live in Texas, where an HIV test is part of routine prenatal laboratory testing at the first obstetric visit (and, again, in the last few months of pregnancy). Each of these women has HIV; two of them found out just because they were tested in pregnancy. One had requested STI (sexually transmitted infection) testing in the past and discovered she had HIV before becoming pregnant.
Prior to the mid-1990’s these women would have been at risk for dying of AIDS within ten years of becoming infected with HIV, and 25% of babies born to women with HIV were also infected. However, with the availability of effective “antiretroviral” medications by the early 2000’s, the risk of transmitting HIV to babies dropped to under 1-2%. In 2014 adults with HIV who take daily medication (for some, that means one pill once a day) can expect to have a normal life span.
HIV now falls in the category of a “chronic condition,” akin to diabetes and high blood pressure. One difference is that stigma is often associated with HIV, though, as one woman said, “What was my sin? I loved someone.” By keeping HIV under control with medication, the risk of giving HIV to a sexual partner decreases by 96%. Most newly infected individuals acquire HIV from someone who does not know they have the virus and/or is not on medication. For this reason, the Centers for Disease Control recommends that every individual between the age of 13 and 64 be screened with at least one HIV test.
There are many couples where one partner has HIV and one does not (known as “serodiscordance” or “serodifference”). Using condoms and keeping HIV under control work well for protecting partners, but how does a couple protect the uninfected one when they desire pregnancy? The partner without HIV can now take medication known as “PrEP” (short for pre-exposure prophylaxis) during the weeks before and after conception. Also, using condoms regularly with the exception of the most fertile one to two days of the month also helps. Ovulation predictor kits available in any pharmacy are urine tests that identify the days when the woman has the best chances of conceiving.
Women with HIV in this millennium can plan on long lives and can choose to get pregnant without putting their partners or babies at risk.
Dr. Judy Levison, MD, MPH of Houston, Texas is an Associate Professor, Obstetrics and Gynecology, at the Baylor College of Medicine and is Physician Coordinator of OB/GYN care for HIV-positive women in the Harris Health System.