Striving towards a HIV Free Generation

Sero-discordant couples are characterized as those where one partner is HIV-positive and the other HIV-negative. Tarryn Freeme explores the possibilities of having a HIV-negative baby in this situation.

For some sero-discordant couples, the idea of having their own bundle of joy to coo over and cherish is like wishing the pandemic of HIV/AIDS or global warming never existed. While there are definitely risks involved in trying to conceive a child without spreading any new infections, it is definitely possible for sero-discordant couples to have a healthy HIV-negative child.

What are the risks?

While the obvious risk for sero-discordant couples is that the HIV-negative partner will become infected, the risks can be largely minimized if done correctly and safely. Before attempting to conceive a child, both partners should be tested for STDs, as any infections can lower your immune system and make you more vulnerable to contracting HIV.

The male should also consider circumcision if he has not yet been under the knife. Uncircumcised men are more at risk of contracting HIV because cells in the foreskin are more vulnerable to infection; also uncircumcised HIV-positive men pose a greater risk to an HIV-negative woman.

What to avoid

Couples with differing statuses should plan their ‘big night’ before hand as repeatedly having unprotected sex increases the uninfected partner’s chance of contracting the virus.

By calculating when the women will be ovulating, you are limiting the amount of times the negative partner will be potentially exposed to HIV. Ovulation can be calculated by deducting 14 days from your cycle length. So, if you have a 30 day cycle, you will most likely be ovulating on day 16.

The HIV-positive partner should also have his/her viral load determined, as even though it’s not 100% safe, an undetectable viral load will put your partner at a lower risk and minimize their chances of being infected by you.

Planning your conception attempts can limit your chances of HIV infection, but it does not completely eliminate the risk. It is therefore still vitally important that sero-discordant couples continue to practice safe sex and use condoms on days when the possibility of conception is low.

What if the woman is HIV-positive and the man is HIV-negative?

For different status couples, where the woman is the HIV-positive partner, things are slightly less complicated. Depending on how much money you are willing to spend, conceiving a child can be done at home through the tried and tested ‘turkey baster’ method or through artificial insemination (AI) which can be done at a fertility clinic.

Turkey baster method

A couple can keep the man safe while coming as close as possible to a ‘natural’ conception by having sex with a condom and then removing the semen with a syringe. The man can then inject the semen into the neck of the womb, making it slightly more intimate and seeming as if he really is impregnating the woman the natural way.

While there are no statistics on whether this method works or not, as it is a home practice, partners should exercise caution and be gentle. Using a non-lubricated condom during intercourse is also recommended as they will contain absolutely no spermicide. In order to prevent pain and discomfort, consider using your own water-based lubricant that can be applied on the penis before putting on the condom and then on the condom itself again.

Artificial Insemination

If you decide to seek professional help, a clinic will do a blood test to determine the HIV-positive woman’s viral load and her CD4 count. If everything is within normal limits, the male partner will donate a specimen of semen which will then be inserted into the neck of the womb by a specialist.

According to Dr. K. Wiswedel, a fertility specialist at the Cape Fertility Clinic, the process of insemination takes approximately 30 seconds, the same as doing a pap smear. This way couples have the same chance of conceiving through AI as they do through natural conception.

What if the man is HIV-positive and the Woman is HIV-negative?

For sero-different couples, where it is the man that is HIV-positive, the process of conception is a little more complicated. Some clinics in the private sector, such as the Cape Fertility Clinic offer a service known as sperm washing.

Sperm washing is a process where the actual sperm is separated from the seminal fluid. This is done because most of the virus is in the seminal fluid and not in the sperm itself. Dr. K. Wiswedel says the separated sperm is then sent for a Polymerase Chain Reaction (PCR), a test that can detect up to 25 copies of HIV. This test only takes approximately an hour and a half. If the semen specimen then comes back negative, that specimen will be used to inseminate the woman.

While the process of sperm washing and having the laboratory tests done will set you back at approximately R6 000, the risk of transmitting the virus to the uninfected women is reportedly reduced to nearly 0%.

Through sperm washing and artificial insemination, the chances of impregnation are the same as natural conception, that being between 20-25%.

A few winged words

This is an exciting time for any couple, whether the risk of becoming infected with HIV is apparent or not. While your concern as potential ‘parents-to-be’ is to ensure your unborn child is delivered HIV-free, couples should still act safely and responsibly. If one partner has remained HIV-negative, you don’t want to change this over a decision to have a baby.

Consult your nearest clinic, and find out how they can help you and your partner conceive your own little bundle of joy - it need not be a nerve-wrecking experience. It is possible to have a child where both the negative partner and the baby remain HIV-negative, and even more amazing, the possibility of an HIV free generation.

Side Bar

How to prepare when you are intending to fall pregnant

· Fuel up on Folic Acid- Folic acid is a B vitamin (B9) found mostly in leafy green vegetables and enriched grains. Repeated studies have shown that women that get 0.4 milligrams daily, prior to conception and during early pregnancy, reduce the risk of their baby being born with a serious neural tube defect (a birth defect involving incomplete development of the brain and spinal cord) by up to 70%.

· Stop drinking and smoking- Smoking changes the way DNA is packaged in sperm cells therefore making the sperm less motile and decreasing the chances of fertilization. The same applies to alcohol which decreases a woman’s fertility by half and also increases the likelihood of miscarriage if conception occurs.

· Have a semen analysis done- This will determine whether the man’s sperm is fit and healthy and capable of fertilizing the woman’s ovum.

· Schedule a pre-conception visit- While this might sound strange, a pre-conception visit will put your mind at ease once you find out that there are no complications and that you and your partner are healthy and capable of conceiving a child.

· Eat healthy and exercise- By eating properly and doing mild exercise regularly, you will not only be boosting your immune system, but your chances of falling pregnant sooner will also be increased.

· Determine the viral load of infected partner- Having your viral load determined is very important. The HIV-infected partner should have an undetectable viral load as this limits the risk of infection to the uninfected partner.

“Planning your conception attempts can limit your chances of HIV infection, but it does not completely eliminate the risk.”

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