Safer Conception for HIV Serodiscordant Couples
When a couple wants to have a child and one partner has HIV while the other does not (a serodiscordant couple), counseling and care can make these points:
- The partner with HIV should take antiretroviral (ARV) therapy consistently and correctly until the HIV is suppressed to the point that it cannot be detected.
- If the partner with HIV is not virally suppressed on ARV therapy, the partner who does not have HIV (HIV-negative) can consider taking pre-exposure prophylaxis (PrEP) with ARVs during the period when they are trying to conceive (see Fertility Awareness Methods).
- In some settings where available, if the woman has HIV but the man does not, a safe option for conception is artificial insemination with the uninfected partner’s semen.
Both partners should be screened and treated for any other STIs before trying for conception.
People with STIs and people with HIV, whether or not they are taking antiretroviral (ARV) therapy, can start and continue to use most contraceptive methods safely. There are a few limitations, however. See the table below. (Also, every chapter on a contraceptive method provides more information and considerations for clients with HIV, including those taking ARV medications.)
|Method||Has STIs||Has HIV|
IUD or LNG-IUD)
Do not insert an IUD in a woman who is at very high individual risk for gonorrhea and chlamydia, or who currently has gonorrhea, chlamydia, purulent cervicitis, or PID.
(A current IUD user who becomes infected with gonorrhea or chlamydia or develops PID can safely continue using an IUD during and after treatment.)
A woman with HIV clinical disease that is mild or with no symptoms, including a woman on ARV therapy, can have an IUD inserted.
Generally, a woman should not have an IUD inserted if she has HIV clinical disease that is severe or advanced (WHO Stages 3 or 4).
A woman using an IUD who becomes infected with HIV or whose HIV clinical disease becomes severe or advanced (WHO Stages 3 or 4) can safely continue using the IUD.
A woman using an IUD can keep the IUD in place when she starts ARV therapy.
|Female sterilization||If client has gonorrhea, chlamydia, purulent cervicitis, or PID, delay sterilization until the condition is treated and cured.||Women with HIV, including women on ARV therapy, can safely undergo female sterilization. The procedure may need to be delayed if she currently has an HIV-related illness.|
|Vasectomy||If client has scrotal skin infection, active STI, or swollen, tender tip of penis, sperm ducts, or testicles, delay sterilization until the condition
is treated and cured.
|Men who are living with HIV, including men on ARV therapy, can safely undergo vasectomy. The procedure
may need to be delayed if he currently has an HIV-related illness.
|Spermicides (including when used with diaphragm or cervical cap)||Can safely use spermicides.||
Should not use spermicides if at high risk of HIV.
Generally, should not use
|Combined oral contraceptives,
monthly injectables, combined patch, combined ring
|Can safely use combined hormonal methods.||Can safely use combined hormonal methods.|
|Progestin-only pills, injectables, and implants||Can safely use progestin-only methods||
Can safely use progestin only methods.
There is some concern that using a progestin-onlyinjectable could make a woman more likely to develop HIV infection if exposed to the virus (see Progestin-Only Injectables, Question 2) However, a woman whoalready has HIV can safely use a progestin-only injectable.