Can I conceive if I have HIV?

Yes. First consult with a medical professional who is knowledgeable about the use of HIV medications in pregnancy. You need to do this before you become pregnant to prevent you from transmitting HIV to your child. With proper care, you can reduce the risk of transmitting HIV to your baby to less than 1 percent. If possible, take advantage of specialists like those at Johns Hopkins HIV Women’s Health Program, who are experienced in the use of such meds in pregnancy. The program also provides comprehensive social services and referrals to pediatricians. You’re likely to find similar programs at other large health care organizations.

If you are a woman with a male partner who is also HIV-positive, you may be tempted to get pregnant the old-fashioned way: through unprotected sex. However, doing so puts you at risk of reinfection or superinfection, even if both of you have a low or undetectable viral load — although new research on treatment as prevention (TasP; see below) may change some of the recommendations involving that. But it’s safest to utilize the procedure known as “sperm washing,” which can literally wash the HIV from sperm, so you can be inseminated without fear of reinfection or superinfection.

If your baby-daddy is HIV-negative, you may be able to conceive through sexual intercourse if he’s being treated with pre-exposure prophylaxis (PrEP). Sure, it’s not very romantic imagining your doctor involved in your conception process, but the trade-off is having a healthy, HIV-negative baby.

What if my husband, boyfriend, or male partner has HIV, but I’m negative?

Yes, you absolutely can conceive, and in fact, recent research on PrEP and TasP indicate that it’s generally much safer and easier than if your situation were reversed. You’ll still want to have an HIV specialist doctor involved, or at least one who has dealt with using HIV medications and conception before. Your doctor will likely prescribe you PrEP, which when taken appropriately prevents HIV transmission in the majority of cases. You’ll take medication — Truvada, the only drug so far approved by the FDA for PrEP — during the duration of your attempts at old-fashioned procreation. The doctor will also make sure your husband is on treatment and maintaining an “undetectable” viral load (that’s the TasP) and thus has a significantly lowered chance of passing HIV along to you. The new book Positively Negative chronicles two couples utilizing PrEP and/or TasP to conceive this way; you may want to read it.