Yes. With modern antiretroviral therapy, people with HIV conceive, carry pregnancies, and have babies born without HIV. HIV.gov puts the risk of passing HIV to a baby at less than 1% when you take HIV medicine as prescribed through pregnancy and childbirth and the baby receives HIV medicine for 4 to 6 weeks after birth. When you're virally suppressed, conception through condomless sex carries no risk of sexual transmission to a partner without HIV.
Planning ahead: what to line up before you try
The most useful thing you can do is start the conversation early. The federal perinatal guidelines frame the goal for conception plainly: viral suppression should be sustained before attempting conception — for example, two recorded plasma viral load measurements below the limit of detection taken at least 3 months apart — to protect your own health, prevent sexual transmission of HIV, and minimize the risk of transmission to an infant once conception occurs[1].
Alongside that:
- Both partners should be screened and treated for genital tract infections before attempting to conceive, with rescreening considered based on circumstances and how long the preconception period lasts[1].
- Starting ART before pregnancy can further reduce the risk of perinatal transmission, and evidence suggests early and sustained control of HIV decreases that risk. Reports are mixed on possible associations between ART and prematurity or low birthweight — a reason to plan with your team rather than to hesitate[1].
- Care should be coordinated across HIV primary care, obstetrics and gynecology (including reproductive endocrinology and infertility), case management, and peer and social support, with expert consultation when indicated. If conception hasn't happened within 12 months — or sooner based on age or obstetric factors — an infertility workup including semen analysis should be pursued, and earlier evaluation may be warranted given concerns about higher rates of infertility among people with HIV[1].
- Acquiring HIV newly during pregnancy or lactation carries a high risk of transmitting HIV to an infant — which is why partner testing and PrEP matter throughout the preconception and pregnancy period[1].
Conceiving when partners have different HIV status
This is where the guidance is most reassuring. For partners with different HIV status, when the person with HIV is on antiretroviral therapy and has achieved sustained viral suppression, sexual intercourse without a condom allows conception without sexual HIV transmission to the person without HIV[1]. Sustained suppression here means those two viral load measurements below the limit of detection, taken at least 3 months apart[1]. The evidence base the guidelines cite includes HPTN 052, where earlier ART initiation produced a 93% reduction in sexual transmission among couples with different HIV status[1].
PrEP is available as an added layer, and asking for it is not a sign of distrust. Providers should discuss PrEP with all sexually active people without HIV, including when trying to conceive; counseling should cover PrEP's benefits for preventing HIV acquisition and perinatal transmission and its potential adverse effects during the periconception period, pregnancy, postpartum, and breastfeeding. When partners with different HIV status attempt conception, the partner without HIV can choose to take PrEP as an additional method even if the partner with HIV has achieved viral suppression, and where suppression is not established or is unknown, PrEP for the partner without HIV is recommended[2].
CDC adds an anti-gatekeeping principle worth quoting to any hesitant provider: PrEP should not be withheld from patients without HIV who request it, even if their sexual partner with HIV is virally suppressed. CDC lists oral PrEP with F/TDF as generally safe during pregnancy or while breastfeeding, and notes data on cabotegravir-exposed pregnancies are sparse, so injectable PrEP may be initiated or continued when pregnancy may be an option if patient and provider agree the benefits outweigh potential risks. There are no known interactions between PrEP and hormonal contraception[3]. On formulations: TDF/FTC is approved as PrEP for all populations, TAF/FTC is not approved for preventing HIV transmission through receptive vaginal sex, and long-acting injectable cabotegravir was approved for PrEP in 2021[2]. The guidelines note there are now several approved oral and long-acting injectable options for preventing HIV acquisition through receptive vaginal sex, including during pregnancy and breastfeeding, to be chosen through shared decision-making[4].
Sperm washing, IUI, IVF: what changed
If you've read older material, you may expect to be sent for sperm washing. That is no longer the default. Federal guidelines state that the use of sperm preparation techniques — "sperm washing" followed by testing the sample for HIV RNA — coupled with intrauterine insemination, in vitro fertilization, or IVF with intracytoplasmic sperm injection, is no longer routinely recommended. The guidelines note that the appropriate role of semen preparation techniques in the current context is unclear, particularly given their expense and technical requirements, and that these techniques largely were developed before studies demonstrated the efficacy of ART and PrEP[2].
What assisted reproduction is for now: assisted reproductive technologies might be useful in cases of infertility, or for couples using donor sperm or a gestational surrogate[2]. Donor sperm remains an option that eliminates risk to a partner without HIV when the inseminating partner has HIV[2].
And in the reverse situation — when the person with HIV is the one who will carry the pregnancy and the inseminating partner does not have HIV — assisted insemination during the periovulatory period, at home or in a provider's office, using semen from the partner is an option for conception. It eliminates the risk of HIV transmission to the inseminating partner[2]. Note that this is a route for protecting the partner without HIV, not a workaround for a detectable viral load; suppression is still the foundation of the plan[1].
Pregnancy, delivery, and the first weeks
The headline number: if you have HIV and take HIV medicine as prescribed throughout pregnancy and childbirth, and your baby receives HIV medicine for 4 to 6 weeks after birth, your risk of transmitting HIV to your baby can be less than 1% — and the medicine protects your own health as well[5]. For contrast, WHO notes that without intervention the rate of transmission during pregnancy, labor, delivery, or breastfeeding ranges from 15% to 45%. WHO also reports that with lifelong ART, virtual elimination of vertical transmission has been shown to be feasible, and countries are being certified for elimination — the Bahamas on April 22, 2026, and Denmark, the first EU country, on February 27, 2026[6].
Delivery decisions follow your viral load, not your diagnosis. ACOG's guidance (a 2018 committee opinion, paraphrased here in person-first language) states that combination ART can achieve a risk of transmission to the baby of 1–2% or lower when viral loads of 1,000 copies/mL or less are sustained, independent of the route of delivery or duration of ruptured membranes — and that vaginal delivery is appropriate for pregnant people maintained on combination ART with viral loads of 1,000 copies/mL or less at or near delivery[7].
Where the viral load is above 1,000 copies/mL or unknown at or near delivery, ACOG says people should be counseled about the potential benefit of, and offered, scheduled prelabor cesarean delivery at 38 0/7 weeks of gestation. Those patients should also receive intravenous zidovudine (ZDV) — ideally 3 hours preoperatively as a 1-hour loading dose (2 mg/kg), followed by continuous infusion over 2 hours (1 mg/kg/hr) until delivery. At 1,000 copies/mL or less with no adherence concerns, intravenous ZDV is not required, though a clinician may elect to use it based on clinical judgment[7].
After birth, your baby's preventive antiretroviral medication and testing schedule depend on the assessed risk of HIV acquisition. A birth HIV nucleic acid test is recommended in all scenarios except for infants at low risk, and three-drug presumptive treatment for infants at higher risk now consists of ZDV/3TC plus either nevirapine or dolutegravir[4]. Feeding is a separate, supported conversation with its own guidance — see our page on breastfeeding with HIV.
Florida: required testing, Part D care, and 2023 outcomes
Florida requires HIV testing at the first prenatal visit, again at 28 to 32 weeks, and at labor and delivery if status is unknown, under section 384.31, Florida Statutes, and rule 64D-3.042, Florida Administrative Code — which is how most pregnancies involving HIV are identified and treated in time[8]. Practically, that means a Florida pregnancy plan starts with a test you'll be offered by default rather than one you have to request.
For care and cost, TOPWA provides prenatal care, help with HIV testing, family planning, ADAP or Medicaid enrollment, and prevention education in eight counties, and Florida lists Ryan White Part D providers — the part of the Ryan White program focused on women, infants, children, and youth — plus the Baby RxPress voucher program[9]. Nationally, the Ryan White HIV/AIDS Program serves people diagnosed with HIV who are low income for where they live and who have no insurance or insurance that doesn't cover the care they need, offering core medical services (outpatient care, ADAP medications, medical case management, mental health, oral health, medical nutrition therapy) and support services including child care, housing, medical transportation, legal services, and emergency financial assistance — all directly relevant to planning a pregnancy[10].
The results speak for themselves: of 409 infants born in Florida in 2023 with perinatal HIV exposure, 1 was diagnosed with HIV and none with AIDS[8].
Related questions
Can I have a baby if I have HIV?
Yes. HIV.gov states that if you take HIV medicine as prescribed throughout pregnancy and childbirth and your baby receives HIV medicine for 4 to 6 weeks after birth, the risk of transmitting HIV to your baby can be less than 1%. Guidelines recommend sustained viral suppression — two undetectable viral loads at least 3 months apart — before trying to conceive.
Do we still need sperm washing or IVF?
Usually not. Federal guidelines state that sperm preparation techniques such as sperm washing, combined with intrauterine insemination or IVF, are no longer routinely recommended — they were largely developed before the evidence on ART and PrEP. Assisted reproduction is now reserved for infertility, donor sperm, or use of a gestational surrogate.
Is it safe for my partner if we conceive without condoms?
When the partner with HIV is on antiretroviral therapy with sustained viral suppression, the guidelines state that condomless intercourse allows conception without sexual HIV transmission to the partner without HIV. PrEP is available as an added layer if either of you wants it, and CDC says PrEP should not be withheld from someone who requests it even when their partner is virally suppressed.
Will I need a cesarean delivery?
It depends on your viral load, not your diagnosis. ACOG guidance supports vaginal delivery for people on combination ART with a viral load of 1,000 copies/mL or less at or near delivery. If the viral load is above 1,000 copies/mL or unknown, scheduled prelabor cesarean delivery at 38 0/7 weeks should be offered along with intravenous zidovudine.
Related from RiseUpToHIV
References & Sources
- HHS Perinatal HIV Clinical Guidelines — Reproductive Options When One or Both Partners Have HIV. Sustained suppression before conception, STI screening, coordinated care and infertility workup, condomless conception with suppression, and HPTN 052. ↩ ↩ ↩ ↩ ↩ ↩ ↩ ↩ ↩
- HHS Perinatal HIV Clinical Guidelines — Reproductive Options (PDF, Updated January 31, 2024). PrEP recommendations for conception, PrEP formulations, and the statement that sperm preparation with IUI or IVF is no longer routinely recommended. ↩ ↩ ↩ ↩ ↩ ↩
- CDC HIV Nexus — Clinical Guidance for PrEP. PrEP should not be withheld from someone who requests it; safety of oral PrEP in pregnancy and breastfeeding; cabotegravir data limits. ↩
- HHS Perinatal HIV Clinical Guidelines — What's New. Current PrEP options for receptive vaginal sex, and infant preventive antiretroviral and testing recommendations. ↩ ↩
- HIV.gov — Who Should Get Tested?. The under-1% risk of transmitting HIV to a baby with treatment through pregnancy, childbirth, and 4 to 6 weeks of infant medicine. ↩
- WHO — Prevention of Mother-to-Child Transmission of HIV. The 15%–45% untreated transmission range and country certifications for elimination in 2026. ↩
- ACOG — Labor and Delivery Management of Women With Human Immunodeficiency Virus Infection (Committee Opinion, 2018). Vaginal delivery at 1,000 copies/mL or less; scheduled cesarean at 38 0/7 weeks and intravenous zidovudine above 1,000 copies/mL or when unknown. Quoted material paraphrased in person-first language. ↩ ↩
- Florida Department of Health — Epidemiology of HIV in Florida, 2023. Mandatory prenatal HIV testing under s. 384.31 F.S. and 64D-3.042 F.A.C., and 2023 perinatal exposure outcomes. ↩ ↩
- Florida Department of Health — Perinatal HIV Prevention. TOPWA services and counties, the Ryan White Part D provider list, and the Baby RxPress voucher program. ↩
- HRSA — Available Care and Services, Ryan White HIV/AIDS Program. Eligibility and the core medical and support services available, including child care, housing, and transportation. ↩
Community publications like POZ, Positively Aware, and TheBody inform framing and lived-experience context on RiseUpToHIV. Every clinical, epidemiological, or public-health claim above is anchored to a primary source.