Pre-Conception

A 1999-2001 study carried out with 329 HIV-positive women in Thailand found that some pregnant HIV-positive women (number not specified) who were originally advised to abort by providers (number not specified) but were then counseled on PMTCT subsequently chose to access PMTCT and have a child. One woman said: “A doctor told me about AZT and its effectiveness, that for every 10 children, only 3 to 5 children would contract HIV [an erroneous statement]. I wanted to try. I really needed my child so the information I learned from the doctor made me happier and I decided to keep my pregnancy and wait for the day that I would meet my child” (p. 39). The women were interviewed using a structured questionnaire. In-depth interviews were conducted among 60 HIV- positive women. Four participatory workshops were held on data analysis and report writing. Women interviewed were selected non-randomly from support groups, clinics, ANC clinics, NGOs and communities using dimensional sampling method. The dimensions used were age (15-25, 26-35, 36-49) and number of years from diagnosis. Women who met the criteria for both dimensions were selected based on convenient or snowball sampling techniques. Six focus group discussions were held with six to eight men.

Evaluation of the mothers2mothers (m2m) program in South Africa found that the m2m program provided a strong continuum of care to the women and infants. Compared to non-participants, m2m participants had greater psychosocial well- being and greater use of PMTCT services and outcomes. Postpartum program participants were significantly more likely to have disclosed their status to someone than non-participants, and to have done so prior to delivery. m2m seeks to reduce PMTCT, empower pregnant and postpartum women to improve their health and the health of their babies, fight stigma and encourage and support disclosure. The program offered education and psychosocial support to HIV- positive pregnant women and new mothers, assisted women to access PMTCT services, and followed up to ensure care of mothers and infants after delivery (Baek et al. 2007).

A study in Cuba found 28 of 55 women interviewed who had given birth in Cuba, said that their worries about transmitting HIV to their child subsided after discussing their pregnancy with doctors, learning about treatment and meeting HIV-positive women who had had HIV-negative children.

A 2008 review of the global literature on gynecologic issues for HIV- positive women found that there is a 4.3% probability of transmission within HIV-positive couples trying to conceive using timed intercourse (timing sex without condoms when the woman is most fertile in order to increase the likelihood of pregnancy). Viral load should be undetectable, STIs should be treated and ovulation predictors should be used to accurately time sexual contact. However, “there are very little data on which to based recommendations to the HIV-positive seroconcordant couple”.

When HIV transmission to the male partner is to be avoided, self- insemination of ejaculated sperm is advised. “…the data on the safety of unprotected intercourse in the HIV-infected serodiscordant couples attempting to conceive are rather limited…”.

A report in Brazil of three HIV-positive women resulted in two HIV- negative babies and a pregnancy at the time of the report at the Mexico IAC in 2008. All partners were tested for STIs. The couples were instructed to have sexual intercourse with a condom without additives during fertile period. After ejaculation into the condom, they collected semen in a cup, put the semen in a syringe and injected it slowly into the vagina without air, near to the cervix. Women then remained with their pelvis elevated for half an hour with minimal movement. Two of the women were on HAART; the other received HAART for PMTCT . (Abstract)

A study in Thailand of 73 serodiscordant couples, where the man was HIV- positive and the woman was HIV-negative, using sperm washing resulted in a pregnancy rate of over 12% with all pregnant women continuing to test HIV- negative . Sperm washing isolates HIV-1 free spermatozoa tested for the presence of HIV and different assisted reproductive techniques can be used, such as intrauterine insemination. No cases of seroconversion were shown in 4,000 cycles of sperm washing (Bujan et al., 2007; Barreiro et al., 2006 cited in Coll et al., 2008).

A study in Italy from 2001 to 2003 with 43 couples with seropositive male and seronegative females where sperm samples were washed and used for fertilization resulted in a pregnancy rate of over 51%, with no seroconversion detected.