HIV and Pregnancy: What Is Known

Pregnancy and HIV are often discussed as though they cannot coexist, but medical practice has changed a great deal since the early years of the epidemic. With treatment and prenatal care, many women living with HIV have healthy pregnancies and children who do not have the virus. Community educators at AIDS organizations have examined this subject, along with the attitudes that surround it.

Stigma around reproductive choice

Surveys of women living with HIV have found that stigma and discrimination are especially sharp in reproductive health. Some respondents report knowing more about HIV and pregnancy than their own health care workers did, and some report being urged to end a pregnancy on the grounds that the child would certainly be born with HIV, a claim that is misleading given how low transmission rates are with treatment. Canadian law and professional ethics treat decisions about bearing children as a personal right.

Transmission routes

HIV can pass from parent to child before birth, during delivery and through breast milk. Higher maternal viral loads are linked with higher transmission risk, while a well-controlled infection lowers it. Without treatment, the chance of transmission has been estimated at roughly one in four, while with effective treatment and care the chance is very low, often cited as under 1 percent.

For couples where only one partner has HIV, fertility clinics and HIV specialists can discuss options for conceiving, and sustained treatment that keeps the viral load undetectable is widely understood to prevent sexual transmission. Availability of fertility services varies across provinces and territories, and costs can be significant.

Delivery and procedures

Many women with well-controlled HIV plan a vaginal birth, though a caesarean section is sometimes chosen when a high viral load is a concern. Some invasive prenatal procedures may raise transmission risk when the viral load is not controlled, while ultrasound does not. Guidance on infant feeding has changed over time and is individualized, with care teams discussing the risks and benefits with each parent.

Testing approaches across provinces

Prenatal HIV testing in Canada follows two models, and practice varies by province and territory. In an opt-in approach, a doctor asks about testing and counselling accompanies it. In an opt-out approach, testing is included in routine prenatal bloodwork unless a woman declines. Critics of opt-out testing argue that it can reduce pre-test counselling, while supporters point to higher testing uptake.

A positive result during pregnancy can be overwhelming. Care teams and community support groups exist in many cities to provide treatment, counselling and peer support.