So, today, December 1, 2009, is World Aids Day. There is a lot of information out there but I was amazed at some of the things I learned today at www.aids.gov. The most amazing information I learned was about HIV-positive women and men who want to be parents, whether it is biologically or by adopting.
If you want to be a parent, having HIV shouldn’t stop you. There are a number of options for both HIV-positive women and men.
If you are an HIV-positive woman and you are pregnant—or want to become pregnant—the first thing you should do is talk with your health care provider. There are medications you can take during pregnancy, labor, and delivery to help prevent your baby from being infected with HIV.
If you have not been taking antiretroviral medications (ARVs), you can start taking them safely at the beginning of your second trimester of pregnancy (12 weeks). If you are already on ARVs and become pregnant, you should talk to your healthcare provider immediately to make sure you are taking the safest ARVs during your pregnancy. In most cases, women continue on the medications they were taking before becoming pregnant—but you and your healthcare provider should discuss your options and make the decision that fits your situation best.
It is better to be treated with ARVs throughout your pregnancy, but you can still receive treatment even during labor and delivery. It’s important to tell medical staff at the hospital or clinic where you go to deliver that you are HIV-positive, so that they can give you medication to protect your baby.
If you are an HIV-positive man, sperm washing may be an option for you and your partner. Sperm are carried in seminal fluid , which contains some of the highest concentrations of HIV of any bodily fluid. Sperm washing involves taking a sample of semen , and washing the seminal fluid away in a laboratory, so that only uninfected sperm are left.
This process appears to significantly decrease the risk of HIV infection from HIV-positive males to HIV-negative females. The process is still controversial, however. In 1990, CDC issued a recommendation against sperm washing , citing a case in which a previously HIV-negative woman was found to be HIV-positive after she was inseminated with “washed” sperm from her HIV-positive husband. That recommendation has never been revised. More recent studies have found sperm washing to be a safe way for serodiscordant couples to conceive, as long as the washing is done by qualified medical personnel. For more information, see the September 2007 edition of AIDS: Official Journal of the International AIDS Society The process can be time-consuming and very expensive, and it is rarely covered by insurance. Consult with your healthcare provider for more information.
Artificial insemination with donor sperm and adoption services are additional options to help HIV-positive men and women to become parents. Female partners of HIV-positive men have the option of artificial insemination using donor sperm from a sperm bank in order to get pregnant. By law, donor sperm samples are tested for HIV, so women who are artificially inseminated with donor sperm are protected against HIV infection.
Adoption is another option for people living with HIV/AIDS who want to have children. The Americans with Disabilities Act (ADA) prohibits adoption agencies from discriminating against couples or individuals living with HIV/AIDS. Your HIV/AIDS service providers may be able to refer your to the proper agencies or organizations and help you begin the adoption process.
PERINATAL OR VERTICAL TRANSMISSION
Mother-to-child transmission (also known as “perinatal” or “vertical transmission“) is the most common way in which children become infected with HIV. Infants who are HIV-positive may have been infected during the mother’s pregnancy, during vaginal childbirth or by drinking infected breast milk from their HIV-positive mother.
There are treatments that can protect newborns from HIV infection. When HIV-positive mothers receive antiretroviral drug therapy during pregnancy, labor, and delivery and have their babies by Cesarean section , the rate of perinatal HIV transmission falls to 2% for Newborns or less. (Newborns with HIV-positive mothers are also given antiretroviral drugs at birth.)
There are also treatment options for women who do not discover they are HIV-positive until they are already in labor. If they receive medications during labor and delivery, the rate of HIV transmission can still be decreased to less than 10%. An HIV-positive mother who is not on antiretroviral drugs during pregnancy, labor, or delivery has a 25% chance of passing the virus to her baby. For more information, see CDC’s Mother-to-Child (Perinatal) HIV Transmission and Prevention .
The CDC recommends that all pregnant women be tested for HIV—but not all healthcare facilities offer an automatic HIV test for pregnant women. If you are pregnant and have reason to believe you might have been exposed to HIV or a sexually transmitted disease (STD), it is critically important that you request an HIV test.
All children born to HIV-positive mothers have antibodies to HIV. These were made by their mother’s immune system and they enter the baby’s bloodstream before birth. The antibodies can be present for up to 18 months, but they reflect the mother’s infection status, not necessarily the baby’s. This means that standard tests for HIV infection are not useful in newborns or young infants.
Healthcare providers use special HIV tests that can actually detect very small quantities of the virus itself in the blood of children who are younger than 6 months of age. (Most HIV tests look for antibodies to the virus, not the virus itself.) With these tests, doctors can identify approximately 90% of HIV-infected infants by 2 months of age, and 95% by 3 months of age.
HIV experts recommend that all babies born to an HIV-positive mother be tested for HIV at intervals after birth. In 2008, 10 states required mandatory HIV testing of newborns if their mothers were HIV-positive or if the mother’s HIV status was unknown at the time of birth. If you are HIV-positive and pregnant, it’s important you talk to your healthcare provider about treatment plans for you and your baby after you deliver.
If you are currently taking any medications, you should never stop without talking to your doctor first. Stopping HIV treatment can cause serious complications for you and your baby.
For more information, visit the CDC’s HIV/AIDS and Pregnancy and Childbirth .
Let’s remember also to teach our children about HIV and AIDS. I am a firm believer that you must talk to your children and even grandchildren about what is happening in the world today and this is one of the most important things you can teach them. Below is a video that is made by teenagers.
BLOOD TRANSFUSIONS AND ORGAN DONATION
The other interesting thing I learned is about blood transfusions and organ donation. Approximately 25 years ago, I had a necessary surgery and things went terribly wrong. I hemorrhaged and required several transfusions. This was in the days when HIV and Aids testing were fairly new. During my recovery period, I was notified by the blood bank that had collected the blood used during my surgery, that they had a donor who now tested positive for Aids. I was informed that I would need a test and another one in several months. Both of these tests came back negative, but I was informed that I would not be able to donate blood for the next 10 years to be on the safe side. I can tell you that during these months waiting for the test results to come back, every once in awhile it would pop into my mind that there was a chance that I would test positive. This concerned me because at the time, I had 2 young sons at home that I was responsible for.
In the early years of the HIV epidemic, blood transfusions and blood products were a prime source of HIV infection. In 1985, however, an HIV test became available, and screening of all blood donations became mandatory. Of those who contracted HIV through blood transfusions or products, nearly all did so before 1985.
The U.S. blood supply is now among the safest in the world: All blood donors are prescreened for HIV risk factors. Three different HIV screening tests, including the p24 antigen test, are performed on all donated blood. Blood and blood products that test positive for HIV are safely discarded and are not used for transfusions. Donors whose blood tests positive for HIV are notified by the collecting agency. It is important to know that you cannot get HIV from donating blood. Blood collection procedures are highly regulated and safe.
If you know in advance that you are going to need blood for surgery, you can choose to donate and store your own blood with a blood banking service. This is called an autologous donation.
Using Blood Donation to Learn Your HIV Status
Some people think that donating blood is a more private way to learn their HIV status than asking their doctor for an HIV test or visiting a clinic. You should not donate blood to find out if you are HIV-positive . Why? Because the HIV tests used to screen donor blood are highly accurate—but they aren’t perfect. If you have been infected with HIV recently, even the most sensitive test may not show it, but you could still infect others who receive your blood. If you have engaged in high-risk sexual or drug taking behaviors, you should not donate blood. To learn your HIV status, go to www.HIVtest.org and find an HIV testing center. By taking an HIV test, you can protect your own health, as well as the health of people who need blood!
For more information, see CDC’s How safe is the blood supply in the United States ?
The U.S. Food and Drug Administration (FDA) regulates the U.S. blood supply and safeguards over 3.5 million blood transfusion recipients each year. The FDA also certifies all assay test kits used to detect diseases in donated blood.
Each unit of donated blood is tested for:
- Hepatitis B and C ( HBV and HCV )
- Human Immunodeficiency Virus (HIV 1 and HIV2)
- Human T-Lymphotropic Virus (Types I and II)
For more information, see FDA’s Keeping Blood Transfusions Safe.
The risks of transplant-related HIV infection are low. All donor organs are screened for infectious diseases, including HIV. But HIV tests do not always detect the virus in people with very recent infection.
In 2007, there were four documented cases of HIV spread through organ transplants. These were the first cases in 20 years, and they were linked to a single donor, who tested negative for HIV inpre-transplant testing. Patients awaiting organ transplant need to be aware of the very small risk of HIV infection—and to balance that risk against their particular health needs and the limited availability of donor organs.
The CDC has issued criteria designed to identify “high-risk” organ donors and to exclude them from donating organs or tissue in most circumstances. Because of the very limited number of organs available for transplant, however, the CDC’s guidelines state that high-risk donors are acceptable if “the risk to the recipient of not performing the transplant is deemed to be greater than the risk of HIV transmission and disease.”
For more information, you can check out the additional resources below.
NIH -Fact Sheet: Transfusion Safety
FDA -Complete List of Donor Screening Assays for Infectious Agents and HIV Diagnostic Assays
CDC -Guidelines for Preventing Transmission of Human Immunodeficiency Virus Through Transplantation of Human Tissue and Organs.
Click here for a list of HIV/AIDS related Resources and Agencies and the President’s Emergency Plan for AIDS Relief – Report on Blood Safety and HIV/AIDS.