HIV/AIDS is spread all around the globe in a pandemic form. There are millions affected by it due to various reasons.

They are in various stages of illness. Some are symptom free but some may be suffering from recurrent infections or some chronic illness.

Majority of these individuals are young adults in prime of their lives. Like any other person of that age, they also have desire to marry and raise a family. 

This is where they cannot just go ahead like any other   normal   person. There are many issues to be considered.  First and foremost is whether one of the partners is HIV positive   and is the other partner aware of this fact?

If one is positive and the other partner negative then the uninfected partner is at risk of being infected by unprotected sexual relations.

Both the partners may be infected and they may be  knowing this or may be ignorant of this fact.  But in both situations the baby is likely to get infected by transmission of HIV through the placenta, through the vagina during delivery and through breast milk while feeding after birth.

The couple should be made aware of the future possibilities. If both the  parents or one of them is very sick with HIV, possibility of early death due to  opportunistic infections remains real. 

That means high chances of leaving the child to be an orphan at mercy of relatives or some charitable organization.  More immune depressed a parent or both parents are, more real is this grim possibility. 

If the parent/parents are on ARV they are potentially at risk of developing side effects or treatment failure due to antiretroviral drugs over the years. This again means a sick parent.

The child born may be HIV +ve due to no fault of his, because of acquiring infection from his mother. Thus the child is exposed to the possibilities of  being stigmatized for being HIV positive  and has life long susceptibility to oppurtunistic infections.

When  put on ARV therapy he has to comply with it for rest of his life and thus can develop adverse effects of drugs.
Usually an immune depressed individual does not talk about his/her will to raise a family with the doctor.

Medical personnel also  do not have time to discuss these issues  in busy consultations . But they are real practical problems and need to be discussed.

A couple is advised against unprotected sex   to prevent  transmission  and acquisition  of infections, particularly HIV and sexually transmitted diseases. But that is also a pre requisite for becoming pregnant to have a child.  Ideally,    before going ahead with pregnancy HIV status of both the partners should be determined.

Now if  the woman  is positive, her husband   HIV negative, artificial insemination using sperm of husband should be considered as an option to unprotected sex .

This would minimize the chances of the husband getting infected. In a reverse situation where the husband is positive but wife seronegative,  sperms of the husband are washed and then artificial insemination is carried out.

Unfortunately sperm washing techniques are not readily available and expensive where available.

If the mother to be has a good immune status, she should be advised to take a good nutritious diet, keep away from alcohol and smoking to keep her general health in good condition.

From 7th month onwards she has to take antiretroviral therapy   to reduce the risk of the baby acquiring HIV. This eliminates the need for a caesarean section   for delivering the baby which is another option for protecting the baby from infection.

If the mother’s CD4 count is low or she is suffering from oppurtunistic infections, she should start   triple drug  therapy as advised to keep the viral load low.

Antiretroviral therapy taken during pregnancy is known to reduce the risk of transmission of the causative virus to less than 2%.

Breast feeding  is discouraged because that is yet another potential source for infecting the baby.

Thus it is not that HIV +ve couples  should not have children. But while taking this decision, due consideration should be given to their own health and also ensure that the new born does not get infected.

E-mail –rachna212002@yahoo.co.uk