Reproductive decision making

Advice for safer conception varies according to which partner is HIV positive. ‘Serodiscordant’ or ‘serodifferent’ are terms used to describe couples when one partner is HIV positive and the other is HIV negative. All couples who wish to conceive where one or both partners are HIV positive should receive appropriate information regarding all available options and they should be supported in finding the best option for their personal situation.

Treatment as prevention:

A growing evidence base for treatment to reduce transmission is based on studies that found HIV transmission was very rare or did not occur in heterosexual couples when the HIV positive partner had an undetectable viral load on treatment. As such, suppressive ART has expanded the choices available for serodifferent couples to conceive. Hence, the recommendation that all individuals diagnosed with HIV should commence antiretroviral treatment.

Pre-exposure prophylaxis (PreP)

Prep is a way of preventing HIV infection by taking antiretroviral medication on an ongoing basis before sex and continued after sex. It is taken by the HIV negative partner to prevent them from getting HIV. PreP is not indicated when the positive partner has been undetectable on HIV treatment for > 6months. However, it should be discussed with couples, as one of the several options to protect the negative partner during attempts to conceive.

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