Planning a pregnancy with HIV

Human immunodeficiency virus (HIV) damages the immune system, making it harder to fight infections. It can be passed on through blood and other body fluids, for example through sexual contact or infected needles.

There’s no cure for HIV but most people live long, healthy lives with antiretroviral medication. 

HIV can be passed on to babies during pregnancy, birth and breastfeeding. However, by following a treatment plan, there’s a less than 1 in 100 chance of passing HIV to your baby.

Conceiving when one partner has HIV

If a person’s HIV is well managed, and they don’t have a detectable viral load, they can’t pass the virus on through sex. In this case, it’s safe to have unprotected sex (as long as neither of you have any other sexually transmitted infections).

If a person with HIV does have a detectable viral load, they could pass the virus on through sex. The risks may be reduced if the HIV negative partner takes medication to reduce the risk of transmission.

Whatever your status, it’s important to talk to your HIV team before trying to conceive. They can help to make sure you have the healthiest possible pregnancy and baby.

Some women and birthing people with HIV may find it more difficult to get pregnant. This is because HIV can affect certain hormones that are involved with fertility. Speak to your doctor if you’re not pregnant after 6 months of trying.

Testing for HIV during pregnancy

All pregnant people are offered a blood test at their first antenatal appointment (booking appointment). With your permission, one of the things that your blood is tested for is HIV

It’s your choice whether to have this test but it is a good idea. If you do have HIV, a plan will be put in place to help stop it passing to your baby.

You can also have another test later in pregnancy if there’s a chance you were exposed to the virus after the first test. Tell your midwife straight away if you have any concerns that you could have been exposed to HIV during pregnancy. They may offer you medication to reduce the risk of you catching the virus.

If you do get a positive HIV test result for the first time during pregnancy, it’s normal to be distressed, shocked, anxious or depressed. Speak to your medical team, who can refer you for counselling to help you understand and cope with your condition. 

What can I do to reduce the risk of passing HIV on to my baby in pregnancy?

If you already know you have HIV, talk to your HIV team before you get pregnant if possible. If you’re already pregnant, contact your HIV clinic as soon as you can.

If you take antiretroviral medication, don’t stop taking it until you have spoken to your HIV team. They may advise you to change to a medicine that is safer for your baby.

If you don’t already take medication, your doctor may advise you to start taking it during pregnancy to help protect you and your baby.

Your doctor or midwife may refer you to an antenatal HIV team. This team may include an HIV specialist, a doctor who specialises in pregnancy and childbirth (obstetrician), a specialist midwife and a doctor who treats children (paediatrician). They may also put you in touch with local support groups.

If you conceived naturally, and are not sure whether your partner has HIV, it’s important that they get tested.

If your partner does have HIV, it’s important to tell your doctor. However, people living with HIV who are on effective treatment, and have an undetectable viral load, can’t pass the virus on through sex.

You and your health care professional will discuss things you can do to reduce the risk of passing HIV to your baby. They could include the following:

• Taking antiretroviral drugs during your pregnancy.
• Having your baby by c-section if tests show that your level of HIV is high at 36 weeks of pregnancy.
• Taking antiretroviral drugs during labour and delivery if they are recommended.
• Giving antiretroviral drugs to your baby after birth.
• Bottle-feeding instead of breastfeeding if you have a detectable viral load.

By following this guidance, the chance of passing HIV onto your baby is less than 1 in 100.

Giving birth with HIV

Having HIV will affect your choice of where and when to give birth. You may be advised to give birth in hospital, rather than at home, even if your treatment is well-managed.

This is usually recommended because your baby will need to be tested after the birth. They will also be given treatment to prevent the virus being passed to them.

• If the HIV is detectable in your blood, you will be advised to give birth in a hospital by caesarean section. This reduces the chance of passing it on to the baby.
• If the level of HIV in your blood is undetectable, and your HIV is well managed, you may be able to give birth vaginally. This won’t increase the risk of passing it to your baby during the birth.

Your baby will be tested for HIV within 48 hours of birth. They'll usually be tested again at 6 and 12 weeks. A final test is also needed when your baby is 18 months old5. Breastfed babies will need to be tested more often.

Looking after your baby if you’re living with HIV

If your HIV is well controlled with antiretroviral medication, the risk of passing the virus to your baby through breastfeeding is low. Your GP or HIV team can help you choose how you want to feed your baby.

Your baby will have blood tests in the weeks and months after birth to check they haven’t got the virus. If you’re breastfeeding, you and your baby will have these tests more often.

Are you ready to start trying for a baby? Use our free planning for pregnancy tool to get personalised tips for a healthier pregnancy.