Dear Doctor,My husband is HIV positive and I am not. We found out that we are discordant couples after we were already eight months into marriage. I really want to have my own children but scared that of getting infected to. What should I do?Gisele,Kimironko

-----------------------------------Dear Gisele,I can understand your concern as every woman desires to have a baby and is equally concerned about the safety and welfare of her child.  Usually the risk of a married woman getting infected by a HIV seropositive husband is only through unprotected sexual intercourse. This occurs because of the virus being passed in   semen.  Quantity of virus being passed in semen is not much, but since sex is an act done repeatedly, the level of risk increases. When a woman gets infected and becomes pregnant, there is a risk of the baby getting infected through multiple routes. The baby can get infected either in the womb or during delivery through the vagina or later while feeding on breast milk. There can be one or more than one mode of transmission. To prevent the baby getting infected, pregnant mothers who are HIV positive are given antiretroviral therapy (ARV therapy) from the beginning of pregnancy, a program run very effectively by Ministry of Health in Rwanda.You have not stated as to how many months before you have been tested? If more than 3 months have lapsed, you should get tested. If still you are HIV negative, you can consider assisted reproduction. Assisted reproduction techniques are available. HIV positive men can also become fathers without infecting their partners. Intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection are three common assisted reproduction techniques used. Intrauterine insemination is a procedure where the sperm is washed to remove virus and then placed in the partner’s uterus. During In vitro fertilization the eggs are fertilized with sperm outside the body and then inserted into the uterus. Intracytoplasmic sperm injection is an in vitro fertilisation process in which a single sperm cell is injected directly into an egg. The chances of a woman or baby getting infected are very low with these techniques as suggested by various studies. However better results are obtained when the husband is on regular ARV therapy with improvement in the form of low viral load and high CD4 count.  An HIV positive person with high viral load cannot benefit much from these techniques.If both the partners agree, donor semen from a healthy donor can also be used for artificial insemination, thus removing any potential risk of the partner and or baby getting infected. Here the identity of the donor as well as the recipient is kept totally   confidential and not disclosed mutually also. Thus a couple can enjoy having a baby without fear of the wife getting infected.So good luck to you and wish you safe motherhood.