HIV and pregnancy

Many people with HIV (Opens in new tab) choose to have children.

See your doctor before you get pregnant. They will give you advice on how to have a healthy pregnancy.

Your doctor can review your antiretroviral medicines to make sure you are taking the best ones for your situation.

It is rare for a baby to be born with HIV in Australia.

If you are living with HIV (Opens in new tab), you can have unprotected sex (sex without a condom) in order to become pregnant, but only if you are taking antiretroviral treatment and you have a sustained undetectable viral load.

More than 20 years of scientific evidence shows that there is no risk of HIV transmission to your negative partner when you have what is called Undetectable equals Untransmissible (U=U). It means that the HIV viral load (the amount of the virus present in your blood stream) has been reduced to such a low level that it cannot be detected in a standard blood test. The U=U message was recognised globally in 2016.

Read more about U=U (Opens in new tab).

If a male is on antiretroviral therapy which has supressed the virus for a while, the risk of transmitting HIV through unprotected sex is very low.

It’s important to continue to take medicines for HIV as prescribed.

Research shows that it’s safe for you to continue PrEP during pregnancy and when breastfeeding.

In Australia, most pregnant women who are HIV positive choose to take antiretroviral therapy (ART) during pregnancy. This protects the health of both you and your baby.

ART can keep the viral load undetectable (too low to be detected by testing). Having an undetectable viral load reduces the risk of HIV transmission to your baby.

Your HIV viral load is the most important thing in determining your baby’s risk of HIV infection.

Like all women who are pregnant, it’s important that you:

• attend your antenatal appointments
• eat a healthy diet
• get plenty of rest
• get regular exercise

Learn more about having a healthy pregnancy.

The safest way to birth your baby depends on whether you have an undetectable viral load. 

If you have an undetectable HIV viral load, a vaginal birth will not increase the risk of HIV transmission to your baby.

If you have a high viral load, your doctor will advise you to have a caesarean section.
It’s a good idea to write a birth plan with different options, depending on your viral load.

Although your doctor will advise you about your birth options, you can choose how you have your baby. You can have a planned caesarean even if you have an undetectable viral load.

After your baby is born, they will usually be given antiretroviral medicine (sometimes called post exposure prophylaxis or PEP). 

This is a medicine to lower the chance of HIV infection. 

Your baby will usually start this medicine within a few hours of birth. 

How long your baby needs it for depends on the level of HIV transmission risk.

• In very low risk or low risk situations, PEP may be given for about 2 weeks.
• If the risk is higher, PEP may be given for 4 to 6 weeks.

Your baby will also have HIV tests after birth.

Testing is done at different times, and follow up can continue until around 18 months of age. 

An HIV antibody test is usually not reliable until later, because a baby can still have maternal antibodies for many months.

If your baby is breastfed, they will need extra HIV testing during breastfeeding, and again after breastfeeding stops. 

Your specialist care team can support you and your baby, including coordinating your baby’s medicines, tests and follow up appointments.

Choosing how to feed your baby can feel like a big decision, especially when you’re balancing health advice, emotions and what matters most to you. 

You may also feel pressure from others - but you deserve supportive, non judgemental care and the chance to make the choice that’s right for you and your baby. 

Your HIV specialist and maternity team can talk you through your options and help you make a plan you feel confident about.

Formula feeding 

If you use infant formula that is prepared safely, there is no risk of passing HIV to your baby through feeding.  

In some places, pasteurised donor human milk from a milk bank may also be an option.

This also removes the risk of HIV transmission through breastfeeding. 
If you choose formula feeding, your midwife can help with practical advice, like safe preparation and cleaning bottles and teats.

Breastfeeding 

HIV can be passed on through breast milk.

However, some women living with HIV can still choose to breastfeed, with specialist care and monitoring. 

In Australia and in other countries, guidance is changing. More evidence now recognises that breastfeeding may be an option for some women when HIV treatment is working well, viral load stays undetectable, and there is close care and monitoring from an experienced healthcare team. 

If you are thinking about breastfeeding, it’s important to do this with specialist support and close follow up. Australian guidance emphasises that staying engaged in care is important if breastfeeding is chosen. 

If you breastfeed, your care team will help you reduce risk as much as possible.

This usually includes:

• Taking your HIV treatment (ART) as prescribed for the whole time you breastfeed, to maintain viral suppression.
• Having more frequent blood tests for you and your baby than if you formula feed.
• This monitoring continues during breastfeeding and for some months after you stop.
• Knowing who to contact if you need urgent advice (it can help to have this written down).
• Your care team should also talk with you about things that can increase risk, and what to do if they happen. 

This includes: 

• mastitis, or cracked or bleeding nipples
• vomiting or diarrhoea in you, which may affect how well ART is absorbed
• tummy upsets in your baby, which can cause gut inflammation 

If you are worried about symptoms like mastitis or bleeding nipples, or you or your baby become unwell, contact your care team straight away.

Read more about living with HIV and breastfeeding (Opens in new tab) from PositiveWomen.

To learn more about HIV and pregnancy, you can visit:

• National Association of People with HIV Australia (Opens in new tab) (NAPWHA)
• Positive Women Victoria (Opens in new tab)
• Living Well (Opens in new tab)

Languages other than English

Read more about living with HIV and having a baby (Opens in new tab) in other languages.