HIV & pregnancy planning — building a family safely.

There is a question people living with HIV have been asking their providers for four decades, and for most of those decades the answer came back wrapped in fear: Can I have a baby? In 2026, the honest answer is yes — and not as a grudging exception, but as ordinary, planned, supported medicine. When a person living with HIV is on antiretroviral therapy and has sustained an undetectable viral load, conception can happen the same way it happens for anyone else: through sex, at home, without a lab in the middle of it.

The federal Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission — the group that writes the U.S. Perinatal HIV Clinical Guidelines — states it plainly. For partners with different HIV status, when the person living with HIV is on ART and has achieved sustained viral suppression, "sexual intercourse without a condom allows conception without sexual HIV transmission to the person without HIV."1 That single sentence replaced years of sperm-washing referrals, insemination protocols, and fertility-clinic gatekeeping.

This page is about the part that comes before pregnancy — the planning stage. Preconception care. Safer conception. Choosing an ART regimen you can stay on through a pregnancy. Deciding whether the partner without HIV wants PrEP as a second layer. Finding a provider who won't flinch. If you're already pregnant, our women and HIV page covers pregnancy and delivery more broadly. This one goes deep on the months before the positive test.

The U=U reproductive reality

Undetectable = Untransmittable is usually explained in the context of sex for pleasure. It applies just as fully to sex for pregnancy. The Perinatal Guidelines state that people living with HIV who take ART as prescribed and maintain a viral load below 200 copies/mL "will not transmit HIV to their sex partners," and that couples should be informed that condomless sex to achieve conception carries no risk of HIV sexual transmission once the partner living with HIV has initiated ART and maintained viral suppression.1

That statement rests on two large studies. HPTN 052 enrolled heterosexual couples with differing HIV status and found that immediately starting ART produced a 93% reduction in sexual HIV transmission — with no genetically linked transmissions at all while the partner living with HIV was virologically suppressed. The PARTNER study followed 1,166 couples with differing status, mostly heterosexual couples and men who have sex with men, in which the partner living with HIV was on suppressive ART with a viral load under 200 copies/mL. Across roughly 58,000 condomless sex acts over a median 1.3 years of follow-up, there were zero transmissions.1

There is also a study built specifically around conception. A prospective cohort of 161 couples with differing HIV status who were actively planning pregnancy — 133 of them with a male partner living with HIV, all on suppressive ART for at least the prior six months — chose natural conception. It produced 144 pregnancies and 107 babies. There were no sexual transmissions to partners and no vertical transmissions to infants.1

What U=U does and doesn't cover in reproduction

U=U is a statement about sexual transmission between adults. Conception involves a third person, eventually, and that changes what you need to know:

• Partner to partner: U=U is definitive. Sustained suppression means no sexual transmission risk during conception attempts.1
• Pregnancy and delivery: extremely low, not literally zero. With fully suppressive ART started before conception and maintained through delivery, the risk to the infant is under 1%.2 ACOG's patient guidance puts it as 99% of people who follow the recommended guidelines will not pass HIV to their babies.8
• Breastfeeding: under 1%, and the framing is different. Suppression reduces breastfeeding transmission risk to less than 1%, "but not zero" — which is why infant feeding gets its own shared decision-making conversation rather than a blanket U=U claim.5

None of those numbers should read as a warning. They should read as a plan: the closer you get to durable, boring, undetectable suppression before you conceive, the smaller every downstream number becomes.

Preconception care — the three-to-six month window

The most useful thing you can do for a future pregnancy happens before there is a pregnancy. The Panel recommends that HIV care include ongoing conversations about reproductive desires and plans throughout care for anyone with childbearing potential, and that the prepregnancy period be used to modify the antiretroviral regimen to optimize suppression and minimize potential adverse effects, and to optimize overall health.2

There is no magic number of weeks in the guidelines. But the definition of sustained suppression — two undetectable viral loads at least three months apart1 — creates a practical floor. If you want to be able to say "I have documented sustained suppression" when you start trying, you need at least three to six months of runway. That window is also long enough to switch a regimen if needed, get vaccines updated, start a prenatal vitamin, and handle anything else that's easier to fix before you're pregnant than during.

Safer conception when the woman is living with HIV

This is, medically, the most straightforward scenario in 2026 — and historically the one loaded with the most stigma.

If you are a woman living with HIV with a male partner who does not have HIV, and you have sustained viral suppression, condomless sex is a conception method that will not transmit HIV to him.1 There is no need for a fertility clinic, no need for a procedure, no need to explain yourself to a receptionist. The risk being managed shifts almost entirely to the pregnancy itself — and that risk is under 1% with suppressive ART maintained from before conception through delivery.2

There is one option specific to this scenario that eliminates even the theoretical concern about transmission to the inseminating partner. When the person providing sperm does not have HIV, assisted insemination during the periovulatory window — using the partner's semen, performed at home or in a provider's office — removes any sexual exposure at all.1 Some couples choose it for peace of mind rather than because the guidelines require it. That's a legitimate reason.

If you're a single woman living with HIV, or in a same-sex relationship

Donor sperm and assisted insemination are the standard paths, and your HIV status is not a barrier to either. The Panel is explicit that the HIV status of one or both parents "should not be a reason to withhold standard-of-care infertility treatment."2 For female partners in a same-sex relationship with different HIV statuses, one option is for the partner without HIV to be the gestational partner — but that is a choice, not an instruction.1 A woman living with HIV who is virally suppressed can carry a pregnancy with a transmission risk under 1%.

Fertility is a real question, and it deserves a real workup

The guidelines say that if conception hasn't happened within 12 months, providers should pursue an infertility workup — and that a shorter interval may be appropriate based on age or other obstetric factors. Earlier evaluation may be indicated because of concerns about higher rates of infertility among people living with HIV.1 This matters because a real pattern in HIV care is that fertility problems in people living with HIV get attributed to HIV and then left alone. Ask for the workup. Ask for the referral to reproductive endocrinology and infertility. The Panel recommends coordination across HIV primary care, obstetrics and gynecology, reproductive endocrinology, case management, and peer and social support.1

Safer conception when the man is living with HIV

For roughly twenty-five years, this scenario had a standard answer: sperm washing. A semen specimen was separated, the sperm fraction was washed free of seminal plasma, the sample was tested for HIV, and only virus-negative sperm were used for intrauterine insemination or IVF. It worked, it produced thousands of healthy HIV-negative babies, and for couples in the 1990s and 2000s it was often the only path a fertility clinic would agree to.

The Perinatal Guidelines now say that sperm-preparation techniques such as sperm washing followed by HIV RNA testing, combined with intrauterine insemination, IVF, or IVF with intracytoplasmic sperm injection, are no longer routinely recommended. The Panel notes that the appropriate role of semen-preparation techniques is unclear given their expense and technical requirements, and that these methods were largely developed before studies demonstrated that ART and PrEP prevent transmission to sexual partners.1

What replaced it: if you are a man living with HIV with sustained viral suppression, and your partner does not have HIV, you can conceive through condomless sex without transmitting HIV to her.1 That is the recommendation. Not a workaround.

Community accounts from the sperm-washing era are worth reading, because they carry the emotional weight the guidelines don't. POZ profiled Ben and Kasiah Banks — Ben living with HIV since a 1981 blood transfusion, diagnosed at 12; Kasiah, a nurse practitioner, HIV negative. They knew they wanted a family "though we didn't know what that was going to look like initially." They conceived through sperm washing and artificial insemination. It took five attempts. Their daughter Finley was born in April 2013, HIV negative. "We got a beautiful healthy baby girl who is HIV negative," Kasiah told the magazine.14

Five attempts. That's the cost that ART-based conception removes for most couples now.

Semen analysis is still part of the picture

One thing that hasn't changed: if conception isn't happening, the infertility workup should include a semen analysis. HIV, and possibly antiretroviral drugs, can be associated with a greater prevalence of semen abnormalities — low sperm count, low motility, a high rate of abnormal forms, and low semen volume.1 If you and your partner have been trying without success, that's a specific test to ask for rather than a mystery to endure.

Mixed-status couples — PrEP as the extra layer

For mixed-status couples, the question isn't usually "is suppression enough?" The guidelines answer that. The question is whether the partner without HIV wants another layer anyway. The Panel's answer is yes, if they want it: when partners with different HIV status attempt conception, the partner without HIV can choose to take PrEP as an additional HIV prevention method even if the partner living with HIV has achieved viral suppression.1

Note the framing. It's rated as optional — a personal choice, not a clinical necessity when suppression is documented. Nobody should be made to feel that wanting PrEP means they don't trust their partner, and nobody should be made to feel that declining PrEP is reckless.

PrEP moves from optional to recommended in specific circumstances. When conception is being attempted through condomless sex and the partner living with HIV has not achieved viral suppression, has unknown suppression status, or may have inconsistent ART adherence during the periconception period, PrEP for the partner without HIV is recommended to reduce sexual transmission risk.1 Life is not always tidy — a pharmacy gap, a hospitalization, a move, a lost job with lost coverage. PrEP is the thing that holds while suppression is being re-established.

Which PrEP, when pregnancy is the goal

• TDF/FTC is the Panel's preference when pregnancy is planned. Tenofovir disoproxil fumarate plus emtricitabine is FDA-approved for PrEP for all populations, and the Panel recommends TDF/FTC whenever possible when PrEP is indicated and pregnancy is planned.1
• TAF/FTC has a coverage gap that matters here. The tenofovir alafenamide plus FTC combination is approved for PrEP but not approved for preventing HIV transmission through receptive vaginal sex — which is precisely the exposure at issue for a woman trying to conceive.1
• Long-acting injectable cabotegravir needs a conversation. CAB-LA was approved in 2021 for men and women, but limited safety and pharmacokinetic data are available to inform efficacy or safety for personal or fetal health when planning pregnancy. If pregnancy occurs on CAB PrEP, the limited safety data and cabotegravir's long half-life should be discussed, and shared decision-making should cover whether to continue or switch to TDF/FTC.1

Testing rhythm matters too. CDC recommends HIV testing every three months for the partner without HIV while attempting conception through condomless sex.1 And if the pregnant person is the one without HIV and their partner is living with HIV, HIV testing should be performed every trimester.1 That's not suspicion. It's the same logic as any other prenatal lab drawn more than once.

Our PrEP page covers access, cost, and the injectable options in more depth, and the U=U page covers the evidence base for treatment as prevention. Sex and HIV covers the day-to-day of mixed-status intimacy outside of conception.

ART regimens and pregnancy — including the dolutegravir story

Choosing a regimen you can stay on through conception, pregnancy, and postpartum is the technical core of preconception planning. As of the guidelines' most recent updates:

• Bictegravir/TAF/FTC became a Preferred regimen for HIV during pregnancy in June 2025, and a Preferred regimen when trying to conceive if ART and CAB-LA as PrEP have never previously been used. It had previously been classified as Alternative. The Panel based the change on data suggesting sufficient pharmacokinetics, efficacy, and safety in pregnancy.3
• Dolutegravir-based regimens remain central. Preferred regimens for early (acute or recent) HIV infection when ART and CAB-LA PrEP have not previously been used include BIC plus TAF plus FTC, or DTG plus (TAF or TDF) plus (FTC or 3TC).3
• The two-drug regimen DTG/3TC was classified as Alternative in March 2026 for use in pregnancy and when trying to conceive — with conditions: no prior CAB-LA PrEP exposure, HIV RNA at or below 500,000 copies/mL, no evidence of hepatitis B coinfection, and confirmed 3TC susceptibility on current or historical resistance testing.3
• Prior CAB-LA PrEP exposure changes the algorithm. For early HIV infection with a history of CAB-LA as PrEP, initial ART is ritonavir-boosted darunavir with (TAF or TDF) plus (FTC or 3TC); empiric INSTI-containing therapy is not recommended unless genotype testing shows no INSTI resistance.3

The Panel also added guidance in the other direction — against reflexive caution. ART should not be avoided or withheld before conception or in early pregnancy for the purpose of preventing preterm birth, and should not be avoided or withheld to prevent hypertensive disorders of pregnancy, or stopped if those disorders develop.3

The dolutegravir neural tube defect signal — what happened, and where it landed

If you were living with HIV and thinking about pregnancy in 2018, you lived through a scare. An unplanned interim report from the Tsepamo birth outcomes surveillance study in Botswana found four neural tube defects among 426 pregnancies with dolutegravir exposure at conception — 0.94%, far higher than expected. National programs issued cautions; some women were switched off dolutegravir; some were counseled away from pregnancy entirely.

Then more data accumulated, and the signal shrank. By the analysis published in The New England Journal of Medicine covering surveillance through March 2019, five neural tube defects had been found among 1,683 deliveries with dolutegravir at conception — 0.30% — compared with 0.10% for non-dolutegravir ART at conception and 0.08% among mothers without HIV. The authors described the estimated prevalence as having "diminished in magnitude to approximately 3 per 1000 births," representing roughly two excess defects per 1,000 exposures, and characterized the magnitude of risk as remaining under 1%.9

By 2022 the difference had closed. Reporting on the Tsepamo update presented at AIDS 2022, aidsmap summarized that since surveillance began in 2014, ten neural tube defects had been identified among 9,460 infants exposed to dolutegravir at conception — a rate of 0.11% — compared with 0.11% in infants exposed to other antiretroviral therapy and 0.07% in infants born to mothers without HIV. The investigators concluded that dolutegravir at conception is not associated with an increased risk of neural tube defects, and that the findings provide further reassurance that women of childbearing potential can receive dolutegravir-based treatment the same way as other adults.9

Two things are worth carrying out of that history. First, the current guidelines treat dolutegravir as a mainstay of ART for people who may become pregnant.3 Second, the reason we know the 2018 signal didn't hold is that someone was watching — nationwide birth surveillance in Botswana, sustained across a decade, generating the numbers that eventually corrected the alarm it raised.

The longer-term safety picture

Ongoing surveillance continues in the United States as well. The Surveillance Monitoring for ART Toxicities (SMARTT) study, part of the Pediatric HIV/AIDS Cohort Study, follows children who were exposed to HIV and antiretroviral drugs in utero but do not have HIV. Its purpose is to identify potential adverse effects of antiretroviral exposures in infants born to women with HIV and to evaluate associations with specific drugs and drug combinations, monitoring birth outcomes, growth, metabolic and cardiac outcomes, neurological outcomes, neurodevelopment, behavior, language, and hearing — explicitly to help inform treatment guidelines.10

Trials that generate pregnancy-specific data at all are a relatively recent achievement. The IMPAACT network — the International Maternal Pediatric Adolescent AIDS Clinical Trials Network11 — exists specifically to study HIV prevention and treatment in pregnant and postpartum people, infants, children, and adolescents, populations historically excluded from drug development. The PROMISE trials, run through IMPAACT, produced the breastfeeding transmission estimates still cited in the U.S. guidelines today.5

IVF, SPAR, and assisted reproduction for people living with HIV

Assisted reproductive technology hasn't disappeared from the picture — its role has narrowed. The Panel notes that IVF and other assisted reproductive technologies may still be useful in cases of infertility, when donor sperm is being used, or when a gestational surrogate is involved.1 In other words: you may need IVF for the same reasons anyone needs IVF. You should not need it because of HIV.

For couples who still want a semen-testing pathway, the Special Program of Assisted Reproduction (SPAR) at the Bedford Research Foundation — a not-for-profit Massachusetts public charity — remains the longest-running program of its kind, marking 30 years of operation in 2026. SPAR evaluates the partner living with HIV, collects two or three semen specimens, splits each into a portion for infectious-disease testing and a portion for washing and cryopreservation, and uses a highly sensitive PCR test that looks for both free virus (HIV RNA) in seminal plasma and virus carried inside cells (HIV proviral DNA). Only sperm from specimens that test negative are used for fertility treatment. Specimens are also tested for CMV, and for hepatitis B, hepatitis C, chlamydia, and syphilis when indicated. Washed, frozen sperm is shipped to one of nearly 100 collaborating fertility centers worldwide for IVF or insemination.12

SPAR's stated rationale is that HIV can still be found in approximately 15% of semen specimens based on HIV RNA and/or DNA, regardless of viral burden in blood.12 That framing sits alongside — not in place of — the federal guidelines' position that semen preparation is no longer routinely recommended for couples where the partner living with HIV is virally suppressed.1 Both statements can be true at once: proviral DNA is detectable in some specimens, and the clinical outcome data from suppressed couples attempting conception show no transmissions.1 If the residual uncertainty matters to you personally, SPAR exists. If it doesn't, the guidelines don't ask you to use it.

Pregnancy monitoring — the labs that shape the birth plan

Once you're pregnant, the planning you did converts into a monitoring schedule. The single most consequential number is the viral load near delivery, because that's what determines mode of delivery and whether IV medication is used during labor.

The guidelines direct that HIV RNA be assessed at approximately 36 weeks gestation, or within four weeks before anticipated birth.4 That result is the hinge. Adherence should also be assessed at every visit and again on presentation for birth, because a known or suspected adherence gap since the last viral load changes the plan even if that last number was good.4

Alongside HIV-specific labs, prenatal care for a person living with HIV may include reviewing vaccination history, liver function tests, and testing and treatment for other infections including STIs.8 One reassurance worth stating plainly: HIV does not increase the likelihood of a baby having a genetic condition, and fetal genetic testing including amniocentesis or chorionic villus sampling does not carry increased HIV transmission risk when the medication regimen is working well.8

Routine prenatal HIV testing also applies to partners and to pregnant people who don't have HIV. CDC recommends that all pregnant women be tested for HIV as early as possible, preferably at the first prenatal visit, with third-trimester testing before 36 weeks for certain groups, and testing at delivery for anyone not screened during pregnancy.6 If a partner is living with HIV, guidelines call for testing every trimester, and counseling should cover the symptoms of acute HIV — fever, sore throat, rash, muscle and joint aches, diarrhea, headache — because acute HIV during pregnancy or lactation carries a high risk of transmission to the infant.1

Delivery — vaginal birth is the default now

For many years, a scheduled cesarean was standard for pregnant people living with HIV. That is no longer the case, and the change is substantial enough that it's worth knowing before you're in a delivery room being told otherwise.

The current thresholds, from the Perinatal Guidelines:4

If a cesarean was planned for a viral load above 1,000 copies/mL and labor or rupture happens first, management is individualized — the evidence is insufficient to say whether cesarean after labor or rupture reduces transmission at that viral load. Most studies show similar transmission risk for cesarean performed after labor and membrane rupture compared with vaginal birth; one study reported 1.6% with emergency cesarean versus 1.9% with vaginal birth.4

Babies exposed to HIV receive antiretroviral medication after birth. ACOG's patient guidance describes the first dose being given as soon as possible, within 6 to 12 hours after delivery, with treatment continuing for four to six weeks and monitoring for anemia as the most common side effect.8 The guidelines refine this by risk level: infants at low risk — exposed to HIV RNA under 50 copies/mL from 20 weeks gestation through delivery — receive zidovudine alone for two weeks, while infants exposed to viremia of 50 copies/mL or more in the four weeks before delivery receive a three-drug regimen from birth for two to six weeks.3

Postpartum — infant feeding, and what changed

This is the area of perinatal HIV care that has moved most in the last few years, and the area where U.S. and global guidance have converged from opposite directions.

For decades in the United States, the recommendation to people living with HIV was simple and absolute: don't breastfeed. Formula. Full stop. That recommendation existed because formula was safe and available and it eliminated a transmission route. It also meant that people were sometimes reported to child welfare agencies for wanting to nurse their babies, and that HIV status was effectively disclosed to anyone who noticed the bottle.

Current U.S. guidance is different. If ART is taken consistently and the viral load is maintained under 50 copies/mL for at least three months before delivery, counseling should cover formula feeding, banked pasteurized donor human milk, and breastfeeding — and those who choose to breastfeed should be supported in that decision.5

The numbers behind that shift:

• Achieving and maintaining suppression under 50 copies/mL through ART during pregnancy and postpartum decreases breastfeeding transmission risk to less than 1%, but not zero. The counseling example in the guidelines frames it as fewer than 1 of 100 breastfed infants acquiring HIV.5
• A 2025 systematic review and meta-analysis reported a monthly breastfeeding transmission risk of 0.1% when the most recent maternal viral load was under 50 copies/mL (95% CI, 0.0%–0.2%).5
• In the PROMISE trial, estimated transmission rates with maternal ART or infant nevirapine prophylaxis were 0.3% at six months and 0.6% at twelve months.5

If breastfeeding is chosen, exclusive breastfeeding with no formula or other foods through the first six months is recommended, with complementary foods introduced after that and breastfeeding continued if desired. Intermittent formula supplementation may be needed for infant weight loss, supply not yet established, insufficient stored milk, or transient viral load increases — and there is no evidence that supplementation increases HIV acquisition risk when the parent is on ART with maintained suppression.5

Formula or banked pasteurized donor human milk eliminates breastfeeding-associated transmission entirely, and is recommended when ART is not being taken or when suppression has not been achieved during pregnancy — at least through the third trimester — or at delivery.5

Monitoring while breastfeeding

Breastfeeding comes with more monitoring, not less. There are no data establishing the right frequency of maternal viral load testing during breastfeeding; one approach in the guidelines is to check plasma viral load every one to two months. A specific clinician should be designated as responsible for following postpartum viral loads and continuing feeding counseling. If the viral load becomes detectable at 50 copies/mL or above, the recommendation is to temporarily stop or discontinue breastfeeding and start replacement feeding while the viral load is rechecked, causes are assessed, and adherence support is reinforced. If the repeat result is under 50 copies/mL, parent and providers decide jointly whether breastfeeding may resume. At 200 copies/mL or above, most experts recommend permanent discontinuation.5

Why the global guidance always looked different

WHO has long recommended breastfeeding with ART in countries that have opted to promote and support it. WHO advises that mothers living with HIV who are on ART and adherent to therapy breastfeed exclusively for the first six months, add complementary feeding from 6 to 12 months, and continue breastfeeding with complementary feeding until 24 months of age or beyond — a change from earlier advice to stop at 12 months. WHO also states that mixed feeding is better than no breastfeeding for mothers on treatment, and that breastfeeding for less than 12 months is better than never initiating it.7

ACOG's patient-facing guidance now reflects the U.S. shift as well: don't breastfeed if you're not currently taking HIV medication or if your viral load was high during pregnancy, labor, and delivery; formula or pasteurized donor milk from a milk bank ensures HIV won't pass to the baby; and some people on HIV medication with a consistently undetectable viral load may choose to breastfeed, through shared decision-making with the care team and regular follow-up.8

The honest summary: this is a genuinely evolving evidence area. "Under 1% but not zero" is the current accurate statement, and the guidelines ask providers to hand you that number and the options rather than handing you a decision. Postpartum is also when ART adherence gets hardest — the guidelines specifically call for adherence support, continued medication access, case management or social work support, and screening for postpartum depression and other mental health needs.5

Florida: the perinatal system you're entitled to use

Florida has one of the more structured perinatal HIV frameworks in the country, and much of it is written into administrative code rather than left to individual practices.

Under Florida Administrative Code 64D-3.042, practitioners providing prenatal care must test for chlamydia, gonorrhea, hepatitis B, HIV, and syphilis at the initial examination for the current pregnancy, and again at 28 to 32 weeks gestation. Someone with documented HIV need not be retested during that pregnancy. Anyone who presents at delivery or within 30 days postpartum with no record of prenatal care, no record of testing, or no testing after the 27th week must be tested for hepatitis B surface antigen, HIV, and syphilis before discharge.15

Florida also runs the Targeted Outreach for Pregnant Women Act (TOPWA) program, created in 1999, which sends outreach workers into non-traditional venues in high-need communities to find and enroll pregnant women living with HIV or at risk who haven't yet accessed adequate care. TOPWA programs are funded in eight counties — Broward, Duval, Hillsborough, Miami-Dade, Orange, Palm Beach, Pinellas, and St. Lucie — and any pregnant woman who uses substances and is living with or at risk of acquiring HIV is eligible. Enrolled participants can get help with HIV testing, family planning, ADAP or Medicaid enrollment, prenatal care access, and HIV prevention education.15

Practical translation: if you're planning a pregnancy in Florida and living with HIV, your care can be assembled from parts that already exist and are already funded — a Ryan White clinic for your own ART and viral load monitoring, an OB practice for prenatal care, a TOPWA outreach worker if you're in one of the eight funded counties and need help navigating, and a pediatric HIV referral center lined up before delivery for your baby's follow-up testing. Ask your case manager to make those connections during the planning stage rather than in the third trimester. Our women and HIV page has more on Florida services for women living with HIV.

The emotional realities — stigma, providers, and choosing your team

Everything above is the clinical part, and the clinical part is the easier part. The harder part is that people living with HIV who want children still routinely encounter providers who react badly.

The Well Project — founded by Dawn Averitt, who is living with HIV — describes the pattern directly: despite the number of people living with HIV who want to become pregnant, access to information, options, and therapies can be limited; many providers don't discuss family planning with patients living with HIV; some don't have enough information to share; and some openly discourage people living with HIV from having children.13 Averitt has written about asking providers about becoming pregnant more than fifteen years ago and receiving very negative reactions before finding one who supported her. She went on to have two healthy HIV-negative daughters.13

How to find an HIV-competent OB/GYN

There is no national registry, so this is a matter of asking better questions earlier:

1. Start with your HIV provider, not the OB. Your HIV clinician or Ryan White case manager almost certainly knows which local OB practices handle pregnancies for people living with HIV routinely. That referral is worth more than any online directory.
2. Ask a screening question on the first call. Something like: "I'm living with HIV and undetectable, and I'm planning a pregnancy — does this practice follow the current federal perinatal HIV guidelines?" The quality of the answer tells you a lot. A practice that says "we'd co-manage with your HIV team and follow the HHS perinatal guidelines" is oriented correctly. A practice that immediately says "you'll need a C-section" is not current.4
3. Use the consultation line as leverage. The National Perinatal HIV/AIDS Clinical Consultation Center at 1-888-448-8765 is free and available to clinicians. A good OB will call it. A defensive one won't. Either way you learn something.4
4. Ask for coordinated care explicitly. The guidelines recommend coordination across HIV primary care, obstetrics and gynecology, reproductive endocrinology and infertility, case management, and peer and social support.1 You can name that list out loud and ask who is filling each role.
5. Look for a family-centered HIV program. Ryan White Part D programs specifically fund family-centered care for women, infants, children, and youth living with HIV. Several Florida sites operate that way. Those clinics have usually done this a hundred times.

Build the non-clinical support too

The Well Project's advice on this is unglamorous and correct: build a strong support network of family, friends, and providers, because a support network helps you make good decisions and get through the negative and disheartening experiences. If you don't have enough supportive people around you, join a support group — or start one.13

Mixed-status couples in particular carry a load that clinical guidelines don't address. The POZ couples profiled in "Drawn Together" mostly talk about communication rather than medicine. Kasiah Banks, whose parents initially worried about her risk before she and Ben educated them, offered this: "My biggest piece of advice is not to let your partner's status be a defining point in your relationship. It is not what makes them who they are."14

One last thing, because it's the thing that gets lost. You do not need to justify wanting a family. The guidelines exist to help you do it safely, not to evaluate whether you should. As The Well Project puts it, people living with HIV ultimately choose when and whether to have children, and deserve to be treated with respect, to have the information necessary to make an informed decision, and to be able to plan for their future.13