Conceiving a child when one or both partners are HIV-positive used to be the stuff of dreams, but today, modern science allows couples to give birth to HIV-negative babies a reality. A short ebook ‘Positively Negative’ by Heather Boerner sheds light on the developments of reproductive health for those living with HIV and the desire amongst adversity to have a family of one’s own. As Boerner describes it “in both straight couples, the man has HIV, and the women and children remain HIV-negative despite having unprotected sex”.
‘Positively Negative’ guides readers on a 15 year long journey, exploring the reproductive decisions of couples in the U.S. and their different assessments of HIV risk acquisition amongst the landscape of emerging HIV research and treatment development. Historically HIV-positive heterosexuals were discouraged from having children and in the early days pregnant women were encouraged to have abortions. Options for serodiscordant couples (in which one partner is HIV-positive and the other HIV-negative) included adoption, the use of donor sperm or egg, or surrogacy. As early HIV treatment became available more options were offered including sperm washing (using chemicals and a centrifuge to separate the sperm from the seminal fluid) with in vitro fertilization (IVF – the process in which the egg is fertilized outside of the body) or intrauterine insemination (IUI – inserting the prepared semen through the cervix into the uterus), however both were expensive and often difficult to access.
The shining light in this story is how Boerner masterfully intersects two key pieces of modern HIV research into the lives of HIV serodiscordant couples trying to conceive.
- The Swiss Statement by Dr Pietro Vernazza (2008) from the Swiss Federal Commission for HIV/AIDS stated a HIV-positive heterosexual person is not sexually infectious if:
- The HIV-positive person had an undetectable viral load (VL < 40 copier/ml) for at least 6 months
- The HIV-positive person adheres to their daily treatment and was regularly monitored
- The heterosexual couple were in a monogamous relationship
- Both partners had no other STI’s
HTPN 052 by Myron Cohen et al. (2011) Prevention of HIV-1 Infection With Early Antiretroviral Therapy
- Early initiation of antiretroviral therapy (ART) in HIV-positive individuals reduced the rates of sexual transmission and clinical symptoms, indicating both personal and public health benefits
- ART reduced the risk of heterosexual transmission by 96%
In the book Boerner follows Susan & Dan Hartmann. They had unprotected sex only when Susan was ovulating and Dan adhered to HIV medication and consistently had an undetectable viral load. Susan meticulously kept calendars and used ovulation-testing kits. They reassessed this process 6 monthly and Susan had the right to refuse unprotected sex at all times. They also openly discussed what it would mean if Susan contracted HIV. It took just two months for the pregnancy test to come back positive. Susan remained HIV-negative. In 2009 their HIV-negative daughter Ryan Nicole was born.
Boerner also followed Ted Baker and Poppy Morgan. They also had unprotected sex with Ted adhering to his HIV medication and consistently having an undetectable viral load. In addition, Poppy took Truvada as a Pre-Exposure Prophylaxis (PrEP) medicine, approved to prevent HIV-negative people from contracting HIV. Poppy continues to keep a blog of their experiences HIV-negative spouses In 2013 their HIV-negative daughter nicknamed Pom-Pom was born.
Some people uneducated about modern HIV treatment may think people living with HIV trying to conceive should not be allowed to have condomless sex. However the evidence is clear and with consistence clinical care there is minimal risk. Both couples in this story were responsible risk takers and their foray into ‘wild unprotected sex’ was instead highly structured.
Boerner also touches on stigma and recognises a difference around fear of the HIV virus between generations. Caroline Watson, born in the late 80’s says:
As long as you’re taking care of it, you’re not going to get sick, you’re not going to get AIDS and you’re not going to die of it.” What you will die of, she said, is shame: People who are ashamed of having the virus don’t go to the doctor and don’t take their medicine. People who are ashamed don’t tell their partners, and put them at greater risk of infection.
While Boerner herself admits to “having grown up in the 80’s, and remembering how terrifying the early virus was, my entire sexual life developed around fear of the virus. As a girl, I wasn’t just afraid of getting pregnant. I was afraid that any little slip up and I could be that girl in a wheelchair in my 20s, dying.” “The more I listened to Watson’s staccato, matter-of-fact cadence as she talked about her approach to the virus, the more I realised that the problem is with me and the rest of us whose image of the virus froze in the 1980s.”
This ebook is a fantastic read not only for serodiscordant couples, but anyone living with HIV, the clinicians, GPs and nurses who treat them and the wider community who are interested in HIV. It sheds light onto the emotional and medical struggles to conceive an HIV-negative child in a time when HIV is classified as a chronic illness and HIV-positive people have a normal life expectancy. Perhaps the only let down is Boerner not following a HIV-positive woman in a serodiscordant relationship conceiving and giving birth to an HIV-negative baby. However, in Boerner’s words ‘it is a story of how super-powerful HIV medications have changed the social landscape as well as the medical one. It is a story of risk and possibility, of the promise of family and the fear of a resurgence of the virus’.
If you are HIV+ and interested in starting a family discuss your options with your HIV clinician
You can find ‘Positively Negative: Love, Pregnancy, and Science’s Surprising Victory Over HIV’ [Kindle Edition] by Heather Boerner here
Check out these links for further information:
- The Washington Post, April 24th 2014, As mixed-status HIV couples weigh risks, more elect to conceive the old-fashioned way
- The Atlantic, October 12th 2014, Getting Pregnant When One Person Has HIV
- Science Journal, Breakthrough of the Year 2011, HIV Treatment as Prevention
- by Pozhet, NSW, Life, Loving and HIV: a heterosexual’s guide to serodiscordant relationships
- by PozHet, NSW, Having a Baby: a guide for HIV positive women, men and their partners