Preventing Perinatal Transmission of HIV
Can a Pregnant Person Transmit HIV to Their Baby?
Yes, however, treatment with a combination of HIV medicines (called antiretroviral therapy or ART) can prevent transmission of HIV to your baby and protect your health.
How Can You Prevent Transmitting HIV to Your Baby?
If you have HIV, there are several steps you can take to reduce your risk of transmitting HIV to your baby.
Get Tested for HIV As Soon As Possible to Know Your Status
- If you are pregnant or planning to get pregnant, get tested for HIV as early as possible during each pregnancy. Knowing your HIV status gives you powerful information.
- If you learn you have HIV, the sooner you start treatment the better—for your health and your baby’s health and to prevent transmitting HIV to your partner.
- If you learn you don’t have HIV, but you are at increased risk of acquiring it, get tested again in your third trimester.
- Know your HIV status. Encourage your partner to get tested for HIV.
HIV-negative but at Risk? Take Medicine to Prevent HIV
- If you have a partner with HIV and you are considering getting pregnant, talk to your health care provider about pre-exposure prophylaxis (PrEP).
- PrEP is medicine people at risk for HIV take to prevent getting HIV from sex or injection drug use. PrEP can stop HIV from taking hold and spreading throughout your body.
- PrEP may be an option to help protect you and your baby from getting HIV while you try to get pregnant, during pregnancy, or while breastfeeding. Find out if PrEP is right for you.
- If your partner has HIV, also encourage them to get and stay on HIV medicine. This will keep them healthy and help prevent them from transmitting HIV to you.
HIV-positive? Take Medicine to Treat HIV
- Taking HIV medicine reduces the amount of HIV in your body (your viral load) to a very low level, called viral suppression. If your viral load is so low that a standard lab test can’t detect it, this is called having an undetectable viral load. Taking HIV medicine and getting and keeping an undetectable viral load is the best thing you can do to stay healthy and prevent transmission to your baby.
- If you have HIV and take HIV medicine as prescribed throughout your pregnancy and childbirth and give HIV medicine to your baby for 2-6 weeks after giving birth, your risk of transmitting HIV to your baby can be less than 1%.
- As long as your viral load remains undetectable, you can have a normal delivery.
- Taking HIV medicine reduces the risk of transmitting HIV to your baby through breastfeeding* to less than 1%. However, the risk is not zero. (See more below)
- Taking HIV medicine also protects your HIV-negative partner. People with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load can live long and healthy lives and will not transmit HIV to their HIV-negative partners through sex.
Are HIV Medicines Safe for You to Use During Pregnancy?
Most HIV medicines are safe to use during pregnancy. Talk with your health care provider about the benefits and risks of specific HIV medicines when deciding which HIV medicines to use during pregnancy or while you are trying to get pregnant.
Can You Breastfeed If You Have HIV?
The current recommendation in the United States supports shared decision-making between you and your health care provider regarding infant feeding. Taking HIV medicine and keeping an undetectable viral load substantially decreases your risk of transmitting HIV to your baby through breastfeeding to less than 1%. However, the risk is not zero. Properly prepared infant formula or banked donor human breastmilk are alternative options that eliminate the risk of transmission through breastfeeding. If you are pregnant or thinking of becoming pregnant, talk to your health care provider as early as possible about what infant feeding choice is right for you.
In January 2023, HHS HIV clinical practice guidelines were updated to incorporate breastfeeding options for people with HIV who are on ART and have a sustained undetectable viral load. Health care providers should refer to the recommendations on Infant Feeding for Individuals with HIV in the United States. Providers are also encouraged to consult the national Perinatal HIV/AIDS hotline (1-888-448-8765) with questions about infant feeding by individuals with HIV.
What Should You Ask Your Health Care Provider About Having a Baby?
You might ask your health care provider some of these questions:
- What is the safest way to conceive?
- Will HIV cause problems for me during pregnancy or delivery?
- Will my HIV treatment cause problems for my baby?
- What are the pros and cons of taking HIV medicine while I am pregnant?
- What infant feeding option is the best choice for me and my baby?
- Is my viral load undetectable?
- How do I avoid transmitting HIV to my partner(s), surrogate, or baby during conception, pregnancy, and delivery?
- What medical and community programs and support groups can help me and my baby?
- What birth control methods are best for me?
Adopting a baby is also an option for people who want to begin or expand their families. The Americans with Disabilities Act does not allow adoption agencies to discriminate against individuals or couples with HIV.
*Following the current recommendation, the term “breastfeeding” is used to describe feeding a child one’s own milk (either direct feeding or with expressed milk). Some transgender men and gender-diverse individuals may prefer using the term “chestfeeding” rather than “breastfeeding.” The recommendations advise health care providers to assess and use an individual’s preferred terminology, and to support all pregnant individuals with HIV, regardless of gender identity, in their infant feeding options.