If you are pregnant or planning to get pregnant, it's important to get tested for HIV as soon as possible. If you find out that do have HIV, you can start treatment right away to protect your health and the health of your baby.

If I have HIV, can I pass it on to my baby during pregnancy?

If you are pregnant and have HIV, there is a risk of passing HIV to your baby. It can happen in three ways:

• During pregnancy
• During childbirth, especially if it is vaginal childbirth
• During breastfeeding

But having HIV doesn't mean that you can't have children. Treatment with a combination of HIV medicines can help prevent passing HIV to your baby and protect your own health.

If I have HIV, how can I prevent giving it to my baby?

There are several different steps you can take to help prevent passing HIV to your baby:

• Taking HIV medicines. HIV medicines reduce the amount of HIV in the body (viral load) to a very low level. The goal is to get your viral load so low that a standard lab test can't detect it. This is called having an "undetectable viral load." Having an undetectable viral load is the best thing you can do to stay healthy and prevent your baby from getting HIV.
  
  These medicines will also help protect your health. Most HIV medicines are safe to use during pregnancy. They don't usually raise the risk of birth defects. But it is important to talk with your health care provider about the risks and benefits of the different medicines. Together you can decide which medicines are right for you. Then you need to make sure you take your medicines regularly.
   
• If needed, having a cesarean delivery. If your viral load is not reduced enough by the medicines, having a cesarean delivery (C-Section) can help prevent passing HIV to your baby.
   
• Giving HIV medicines to the baby. Your baby will get HIV medicines as soon as possible after birth. The medicines protect your baby from infection from any HIV that passed from you during childbirth. Which medicine your baby gets depends on several factors, including what your viral load was just before you gave birth. Your baby will need to take medicines for 4 to 6 weeks. He or she will get several HIV tests over the first few months.
   
• Not breastfeeding. Breast milk can have HIV in it. In the United States, infant formula is safe and readily available. So the Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend that if you have HIV, you should feed your baby formula instead of breastfeeding.

What if I want to get pregnant and my partner has HIV?

If you are trying to get pregnant, it's important for your partner to also get tested for HIV.

If your partner does have HIV and you do not, talk to your provider about taking PrEP. PrEP stands for pre-exposure prophylaxis. This means taking medicines to prevent HIV. The PrEP helps to protect both you and your baby from HIV.

Key Points

• HIV testing determines if a person is infected with HIV. The human immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS). AIDS is the most advanced stage of HIV infection.
• The Centers for Disease Control and Prevention (CDC) recommends that everyone 13 to 64 years of age get tested for HIV at least once as part of routine health care and that people at higher risk for HIV get tested more often. If you are over 64 years of age and at risk for HIV, your health care provider may recommend HIV testing.
• Risk factors for HIV include having vaginal or anal sex with someone who is HIV positive or whose HIV status you do not know; having sex with many partners; and injecting drugs and sharing needles, syringes, or other drug equipment with others.
• CDC recommends that all pregnant women get tested for HIV so that they can begin taking HIV medicines if they are HIV positive.

What is HIV testing?

HIV testing determines if a person is infected with HIV. The human immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS). AIDS is the most advanced stage of HIV infection.

HIV testing can detect HIV infection, but it cannot tell how long a person has had HIV or if the person has AIDS.

Why is HIV testing important?

Knowing your HIV status can help keep you—and others—safe.

If you are HIV negative:

A negative HIV test result shows that you do not have HIV. Continue taking steps to avoid getting HIV, such as using condoms during sex and, if you are at high risk of getting HIV, taking medicines to prevent HIV (called pre-exposure prophylaxis or PrEP). For more information, read the HIVinfo fact sheet on The Basics of HIV Prevention.

If you are HIV positive:

A positive HIV test result shows that you have HIV, but you can still take steps to protect your health. Begin by talking to your health care provider about antiretroviral therapy (ART). People on ART take a combination of HIV medicines every day to treat HIV infection. ART is recommended for everyone who has HIV, and people with HIV should start ART as soon as possible. ART cannot cure HIV, but HIV medicines help people with HIV live longer, healthier lives.

A main goal of ART is to reduce a person’s viral load to an undetectable level. An undetectable viral load means that the level of HIV in the blood is too low to be detected by a viral load test. People with HIV who maintain an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative partner through sex.

Who should get tested for HIV?

The Centers for Disease Control and Prevention (CDC) recommends that everyone 13 to 64 years of age get tested for HIV at least once as part of routine health care. As a general rule, people at higher risk for HIV should get tested each year. Sexually active gay and bisexual men may benefit from getting tested more often, such as every 3 to 6 months. If you are over 64 years of age and at risk, your health care provider may recommend HIV testing.

Factors that increase the risk of HIV include:

• Having vaginal or anal sex with someone who is HIV positive or whose HIV status you do not know
• Injecting drugs and sharing needles, syringes, or other drug equipment with others
• Exchanging sex for money or drugs
• Having a sexually transmitted disease (STD), such as syphilis
• Having sex with anyone who has any of the HIV risk factors listed above

Talk to your health care provider about your risk for HIV and how often you should get tested for HIV.

Should pregnant women get tested for HIV?

CDC recommends that all pregnant women get tested for HIV so that they can begin taking HIV medicines if they are HIV positive. Women with HIV take HIV medicines during pregnancy and childbirth to reduce the risk of perinatal transmission of HIV and to protect their own health.

What are the types of HIV tests?

There are three types of tests used to diagnose HIV infection: antibody tests, antigen/antibody tests, and nucleic acid tests (NATs). Your health care provider can determine the appropriate HIV test for you. How soon each test can detect HIV infection differs, because each test has a different window period. The window period is the time between when a person may have been exposed to HIV and when a test can accurately detect HIV infection.

• Antibody tests check for HIV antibodies in blood or oral fluid. HIV antibodies are disease-fighting proteins that the body produces in response to HIV infection. Most rapid tests and home use tests are antibody tests.
• Antigen/antibody tests can detect both HIV antibodies and HIV antigens (a part of the virus) in the blood.
• NATs look for HIV in the blood.

A person’s initial HIV test will usually be either an antibody test or an antigen/antibody test. NATs are very expensive and not routinely used for HIV screening unless the person had a high-risk exposure or a possible exposure with early symptoms of HIV infection.

When an HIV test is positive, a follow-up test will be conducted. Sometimes people will need to visit a health care provider to take a follow-up test. Other times, the follow-up test may be performed in a lab using the same blood sample that was provided for the first test. A positive follow-up test confirms that a person has HIV.

Talk to your health care provider about your HIV risk factors and the best type of HIV test for you.

Is HIV testing confidential?

HIV testing can be confidential or anonymous.

Confidential testing means that your HIV test results will include your name and other identifying information, and the results will be included in your medical record. HIV-positive test results will be reported to local or state health departments to be counted in statistical reports. Health departments remove all personal information (including names and addresses) from HIV test results before sharing the information with CDC. CDC uses this information for reporting purposes and does not share this information with any other organizations, including insurance companies.

Anonymous testing means you do not have to give your name when you take an HIV test. When you take the test, you receive a number. To get your HIV test results, you give the number instead of your name.

Where can someone get tested for HIV?

Your health care provider can give you an HIV test. HIV testing is also available at many hospitals, medical clinics, substance use programs, and community health centers. Getting tested through a professional health care provider is recommended; however, there are HIV self-testing kits available. Rapid self-test and mail-in self-test are the two types of HIV self-tests, but state laws regarding self-testing may limit their availability in a location.

A rapid self-test is an oral fluid test done entirely at home or in private. There is currently one U.S. Food and Drug Administration (FDA)-approved rapid self-test called OraQuick In-Home HIV test. A mail-in self-test requires a person to provide a blood sample from a fingerstick, which is then sent to a lab for testing.

A study from the Centers for Disease Control and Prevention (CDC) found that the risk for neural tube defects (birth defects of the brain and spine) among pregnancies of women diagnosed with HIV is similar to that of the general U.S. population. Scientists will continue to gather information on mothers and babies affected by HIV during pregnancy to better understand the impact of HIV treatment on birth defects.

Read the full scientific article.

Main Findings

• Linking data from birth defects and HIV/AIDS programs, scientists found that the risk for neural tube defects among pregnancies of women diagnosed with HIV is similar to that of the general U.S. population.
  • About 1 in every 1,250 babies is born with a neural tube defect each year in the United States.

• The strategies used to gather this information show that linking two independent public health tracking systems can help provide a clearer picture of health issues facing mothers and babies.
• HIV treatment options change over time and continued efforts to collect information on pregnancies affected by HIV infection are needed to better understand the link between HIV treatment and neural tube defects.

About This Study

• CDC worked with 15 U.S. states and territories to gather information on more than 64,000 women (aged 13–44 years) living with HIV.
• CDC and its partners will continue to collect information on mothers and babies affected by HIV during pregnancy to understand if any specific treatments are associated with birth defects.

About Birth Defects

Birth defects are structural changes that can affect almost any part of the body, such as the heart, brain, or foot. Birth defects are common, costly, and critical conditions that affect 1 in 33 babies born each year in the United States.

Key Points

• People should get tested for HIV before they become pregnant or as early as possible during each pregnancy and during the third trimester. The earlier HIV is detected, the sooner HIV medicines (also known as antiretrovirals) can be started.
• Perinatal transmission of HIV is when HIV is passed from a person with HIV to their child during pregnancy, childbirth (also called labor and delivery), or breastfeeding (through breast milk). Perinatal transmission of HIV is also called mother-to-child transmission of HIV.
• Pregnant people with HIV should take antiretroviral therapy (ART) throughout pregnancy and childbirth to prevent perinatal transmission of HIV. ART is the use of a combination of HIV medicines (antiretrovirals) to treat HIV. The use of HIV medicines and other strategies have helped lower the rate of perinatal transmission of HIV to 1% or less in the United States and Europe.
• Most pregnant people with HIV can have vaginal deliveries. If someone has a high viral load (more than 1,000 copies/mL) or an unknown viral load near the time of delivery, a scheduled cesarean delivery (sometimes called a C-section) can reduce the risk of perinatal transmission of HIV.
• After birth, babies born to people with HIV should receive HIV medicines to reduce the risk of perinatal transmission. Several factors determine what HIV medicines babies receive and how long they receive the medicines.
• Although HIV can be transmitted through breastfeeding, taking HIV medicines and having an undetectable viral load during pregnancy and throughout breastfeeding lower the risk of passing HIV to less than 1%. Pregnant people with HIV should talk to their health care provider about options for feeding their baby.

Is HIV testing recommended for pregnant people?

The Centers for Disease Control and Prevention (CDC) recommends that all people get tested for HIV before they become pregnant and as early as possible during each pregnancy and in the third trimester. The earlier HIV is detected, the sooner HIV medicines can be started.

All people who are pregnant or trying to get pregnant should encourage their partners also to get tested for HIV and, if possible, screened for other sexually transmitted infections (STIs). STIs can increase the amount of HIV in the body (viral load) in people with HIV. If any partner has HIV, that partner should take HIV medicine as prescribed to stay healthy and prevent transmission.

What is perinatal transmission of HIV?

Perinatal transmission of HIV is when HIV is passed from a person with HIV to their child during pregnancy, childbirth (also called labor and delivery), or breastfeeding (through breast milk). Perinatal transmission of HIV is also called mother-to-child transmission of HIV and vertical transmission of HIV.

The use of HIV medicines and other strategies have helped to lower the rate of perinatal transmission of HIV to 1% or less in the United States and Europe. (HIV medicines are called antiretrovirals.)

How do HIV medicines prevent perinatal transmission of HIV?

Antiretroviral therapy (ART) is the use of HIV medicines to treat HIV infection. Pregnant people with HIV should take HIV medicines to reduce the risk of perinatal transmission of HIV. The earlier HIV medicines are started, the more effective they are at preventing perinatal transmission of HIV. People with HIV who are trying to conceive should start HIV medicines before they become pregnant to prevent perinatal transmission. Pregnant and breastfeeding people with HIV should take HIV medicines throughout pregnancy, childbirth, and breastfeeding to prevent perinatal transmission. HIV medicines also protect the birthing parent’s health.

HIV medicines, when taken as prescribed, prevent HIV from multiplying and reduce viral load. An undetectable viral load is when the level of HIV in the blood is too low to be detected by a viral load test. The risk of perinatal transmission of HIV during pregnancy and childbirth is lowest when a person with HIV has an undetectable viral load. Having an undetectable viral load during pregnancy and throughout breastfeeding lowers the risk of perinatal transmission of HIV to less than 1%. Maintaining an undetectable viral load also helps keep the parent-to-be healthy.

After birth, babies born to people with HIV receive medicines to reduce the risk of transmission of HIV. Several factors determine what medicines babies receive and how long they receive the medicines.

Are HIV medicines safe to use during pregnancy?

HIV medicines are safe to use during pregnancy. HIV medicines do not increase the risk of birth defects. Health care providers discuss the benefits and risks of specific HIV medicines when helping people with HIV decide which medicines to use during pregnancy or while they are trying to conceive. If an individual gets pregnant while on HIV medication, they should stay on that medication unless instructed to change by their health care provider.

Are there other ways to prevent perinatal transmission of HIV?

In people who have a high HIV viral load (more than 1,000 copies/mL) or an unknown viral load near the time of delivery, a cesarean delivery (sometimes called a C-section) can reduce the risk of perinatal transmission.

Pregnant people with HIV are encouraged to talk to their medical team about options for feeding their baby after birth. With consistent use of HIV medicine and an undetectable viral load during pregnancy and throughout breastfeeding, the risk of transmission to a breastfed baby is low: less than 1%, but not zero. Alternatively, properly prepared formula and pasteurized donor human milk from a milk bank are options that eliminate the risk of transmission to a baby after birth. Pregnant people with HIV can speak with their health care provider to determine what method of feeding their baby is right for them.

Additionally, babies should not eat food that was pre-chewed by a person with HIV.

Key Points

• Perinatal transmission of HIV (also called mother-to-child transmission of HIV) is when HIV is passed from a person with HIV to their child during pregnancy, childbirth (also called labor and delivery), or breastfeeding (through breast milk).
• Antiretroviral therapy (ART) is the use of a combination of HIV medicines (antiretrovirals) to treat HIV infection. Babies born to people with HIV should receive ART as soon as possible after birth (preferably within 6 hours of delivery) to prevent perinatal transmission of HIV. HIV medicines protect babies from HIV that could have passed from mother to child during pregnancy or childbirth.
• HIV testing is recommended for all babies born to people with HIV at 14 to 21 days of life, at 1 to 2 months, and again at 4 to 6 months. Additional testing at birth and other time points is recommended for babies at higher risk of perinatal transmission of HIV. If testing shows that a baby has HIV, the baby receives ART.
• Although HIV can be transmitted through breastfeeding, taking HIV medicines and having an undetectable viral load during pregnancy and throughout breastfeeding lower the risk of passing HIV to less than 1%. Pregnant people with HIV should talk to their health care provider about options for feeding their baby.

After birth, do babies born to people with HIV receive HIV medicines to prevent perinatal transmission of HIV?

Antiretroviral therapy (ART) is the use of a combination of HIV medicines to treat HIV infection. After birth, all babies born to people with HIV should receive HIV medicines. This should be given as soon as possible after birth, preferably within 6 hours of delivery, to prevent perinatal transmission of HIV (also called mother-to-child transmission of HIV). HIV medicines given to babies after birth protect against HIV that could have passed from mother to child during pregnancy or childbirth. HIV medicines are called antiretrovirals.

What HIV medicines are given to babies after birth to prevent perinatal transmission of HIV?

The HIV medicine that a baby receives depends on the birthing parent’s viral load and other factors.

Babies at higher risk of perinatal transmission of HIV receive three HIV medicines for up to 6 weeks after birth. This includes babies born to people who are not virally suppressed near delivery.

How soon after birth are babies born to people with HIV tested for HIV?

HIV testing is recommended for all babies born to people with HIV at 14 to 21 days of life, at 1 to 2 months, and again at 4 to 6 months. Additional testing at birth and other time points is recommended for babies at higher risk of perinatal transmission of HIV. The HIV test (called a virologic test) looks for HIV in the blood.

If testing shows that a baby has HIV, the baby receives ART. ART helps people with HIV live long, healthy lives.

What other steps protect babies from HIV?

Pregnant people with HIV are encouraged to talk to their medical team about options for feeding their baby after birth. With consistent use of HIV medication and an undetectable viral load during pregnancy and throughout breastfeeding, the risk of transmission to a breastfed baby is low: less than 1%, but not zero. Alternatively, properly prepared formula and pasteurized donor human milk from a milk bank are options that eliminate the risk of transmission to a baby after birth. Pregnant people with HIV can speak with their health care provider to determine what method of feeding their baby is right for them.

Additionally, babies should not eat food that was pre-chewed by a person with HIV.

Key Points

• All pregnant women with HIV should take HIV medicines throughout pregnancy for their own health and to prevent perinatal transmission of HIV. (HIV medicines are called antiretrovirals). Perinatal transmission of HIV is also called mother-to-child transmission of HIV.
• Most HIV medicines are safe to use during pregnancy. In general, HIV medicines do not increase the risk of birth defects.
• Generally, pregnant women with HIV can use the same HIV treatment regimens recommended for non-pregnant adults—unless the risk of any known side effects to a pregnant woman or her baby outweighs the benefits of a treatment regimen.
• All pregnant women with HIV should start taking HIV medicines as soon as possible during pregnancy. In most cases, women who are already on an effective HIV treatment regimen when they become pregnant should continue using the same regimen throughout their pregnancies.
• A scheduled cesarean delivery (sometimes called a C-section) to prevent perinatal transmission of HIV is recommended for women who have high or unknown viral loads near the time of delivery.

Should women with HIV take HIV medicines during pregnancy?

Yes. All pregnant women with HIV should take HIV medicines throughout pregnancy for their own health and to prevent perinatal transmission of HIV. (HIV medicines are called antiretrovirals.) Perinatal transmission of HIV is also called mother-to-child transmission of HIV.

HIV medicines, when taken as prescribed, prevent HIV from multiplying and reduce the amount of HIV in the body (called the viral load). An undetectable viral load is when the level of HIV in the blood is too low to be detected by a viral load test. The risk of perinatal transmission of HIV during pregnancy and childbirth is lowest when a woman with HIV has an undetectable viral load. Maintaining an undetectable viral load also helps keep the mother-to-be healthy.

Are HIV medicines safe to use during pregnancy?

Most HIV medicines are safe to use during pregnancy. In general, HIV medicines do not increase the risk of birth defects.

When recommending HIV medicines to use during pregnancy, health care providers consider the benefits and risks of specific HIV medicines for women and their unborn babies.

When should pregnant women with HIV start taking HIV medicines?

All pregnant women with HIV should start taking HIV medicines as soon as possible during pregnancy. In most cases, women who are already on an effective HIV treatment regimen when they become pregnant should continue using the same regimen throughout their pregnancies.

What HIV medicines should a pregnant woman with HIV take?

The choice of an HIV treatment regimen to use during pregnancy depends on several factors, including a woman’s current or past use of HIV medicines, other medical conditions she may have, and the results of drug-resistance testing. In general, pregnant women with HIV can use the same HIV treatment regimens recommended for non-pregnant adults—unless the risk of any known side effects to a pregnant woman or her baby outweighs the benefits of a treatment regimen.

Sometimes, a woman’s HIV treatment regimen may change during pregnancy. Women and their health care providers should discuss whether any changes need to be made to an HIV treatment regimen during pregnancy.

Do women with HIV continue to take HIV medicines during childbirth?

Yes. A baby is exposed to any HIV in the mother's blood and other fluids while passing through the birth canal. During childbirth, HIV medicines that pass from mother to baby across the placenta prevent perinatal transmission of HIV, especially near delivery.

Women who are already taking HIV medicines when they go into labor should continue taking their HIV medicines on schedule as much as possible during childbirth.

Can a cesarean delivery reduce the risk of perinatal transmission of HIV?

Yes. A scheduled cesarean delivery (sometimes called a C-section) can reduce the risk of perinatal transmission of HIV in women who have a high viral load (more than 1,000 copies/mL) or an unknown viral load near the time of delivery. A cesarean delivery to reduce the risk of perinatal transmission of HIV is scheduled for the 38^th week of pregnancy, 2 weeks before a woman’s expected due date.

A scheduled C-section to reduce the risk of perinatal transmission of HIV is not routinely recommended for women who are taking HIV medicines and have a viral load of 1,000 copies/mL or less. Of course, regardless of her viral load, a woman with HIV may have a C-section for other medical reasons.

With the help of their health care providers, women can decide which HIV medicines to use during childbirth and whether they should have a scheduled C-section to prevent perinatal transmission of HIV.

Do women with HIV continue to take HIV medicines after childbirth?

Prenatal care for women with HIV includes counseling on the benefits of continuing HIV medicines after childbirth. HIV medicines help people with HIV live longer, healthier lives and reduce the risk of HIV transmission. Together with their health care providers, women with HIV make decisions about continuing or changing their HIV medicines after childbirth.

After birth, babies born to women with HIV receive HIV medicine to reduce the risk of perinatal transmission of HIV. Several factors determine what HIV medicine they receive and how long they receive the medicine.

Q: Can a couple in which one person is HIV positive conceive a baby without the uninfected partner becoming infected?

Many couples in which one person is HIV positive and the other person isn't want to have children. With careful planning, it is possible to have a safe and successful pregnancy while preventing HIV from passing to the HIV-negative partner (or to the baby). It is very important to discuss your desires and intentions for childbearing with your health care provider before the woman decides to become pregnant. Your provider can help with decisions about how to conceive safely (if your provider is not familiar with reproductive issues for HIV, ask to see an HIV specialist).

If you are a woman with HIV and your male partner is HIV negative

A safe and "low-tech" method is to do home insemination using your partner's semen and a needleless syringe, timed with your ovulation. This can be done in the clinic, if you do not feel comfortable doing it at home. Your partner has no possible exposure to HIV with this method.

Fancier approaches are not really needed in this situation unless you and your partner have fertility problems. If you have concerns, you can seek advice and assistance at a fertility clinic or an HIV clinic with experience in preventing perinatal (mother-to-child) transmission of HIV. They may offer insemination services (these services are legal in some states for couples with one HIV-positive partner, but not in all states).

Approaches that involve unprotected sex between the partners can be safe as far as HIV transmission is concerned. Some strategies reduce the likelihood of infection to near zero, though they are not proven to be 100% reliable. Transmission may occur in rare cases. The following approach can be considered, though it has not been studied thoroughly in the context of trying to conceive a baby.

• The woman who is living with HIV takes anti-HIV drugs and has an undetectable viral load; this minimizes the risk of infecting her partner. The couple then has sex without a condom, limited to the time the woman is ovulating (this reduces the number of times they have unprotected sex and thus lowers the risk of HIV transmission). In addition, the HIV-negative male partner may take HIV medications to reduce his risk of infection with HIV, beginning before attempts at conception and continuing afterward (this is called pre-exposure prophylaxis or PrEP), though it is not clear that this step is necessary if the woman's HIV viral load is undetectable.

Women with HIV who become pregnant, regardless of the method, should seek prenatal care, right away, in a program with experts in preventing HIV transmission during pregnancy or at birth.

If you are a man with HIV and your female partner is HIV negative

In this situation, there is no "low-tech" method of conceiving that is 100% safe for the uninfected partner, and many couples prefer "high-tech" approaches. Options include:

• The man with HIV takes anti-HIV drugs and has an undetectable viral load; this minimizes the risk of infecting his partner. The couple then has sex without a condom, limited to the time the woman is ovulating (this reduces the number of times they have unprotected sex and thus lowers the risk of HIV transmission). In addition, the HIV-negative female partner may take HIV medications as prophylaxis to reduce her risk of infection with HIV, beginning in advance of attempts at conception and continuing afterward (this is called pre-exposure prophylaxis or PrEP), though it is not clear that this step is necessary if the man's HIV viral load is undetectable.
• Sperm washing with in vitro fertilization or intrauterine insemination may be considered. Sperm washing is intended to isolate individual sperm from the HIV virus in the semen. These methods require the assistance of a reproductive specialist or fertility clinic. For couples with different HIV status, these services are legal in some states, but not in all.

Q: Can two HIV-positive parents have an HIV-negative child?

Yes, they can. Although HIV can pass from a woman with HIV to her child during pregnancy, at the time of birth, or when breast-feeding the infant, medical treatment of both the mother and her infant can minimize the chances of that happening.

Q: When should couples with HIV seek counseling?

For their own peace of mind, couples with HIV wanting to have children should receive counseling before making a decision about conception. During counseling sessions, they should ask about ways to minimize the risk to the baby, and how to deal with the possibility of infection. If their health is frail, they should discuss the likelihood that they will survive long enough to parent effectively. And they should learn how to cope if members of their family or community judge and stigmatize them or their child.

Q: When should a woman planning to become pregnant start anti-retroviral therapy?

Women living with HIV ideally should start antiretroviral therapy (ART) before pregnancy, both for their own health and to reduce the risk of HIV transmission during pregnancy. Women already on ART should continue to receive it during pregnancy. The goal is to lower the mother's HIV viral load (the concentration of HIV in her blood) to "undetectable" levels to prevent infection of the fetus. The lower the mother's viral load during pregnancy and birth, the lower the risk of infecting her baby. A baby's chances of being born with HIV are about 0.4% when the mother has a viral load so low that it's undetectable.

Q: Should the newborn child be treated?

After delivery, the infant should receive ART for at least 4-6 weeks. Longer durations of therapy are appropriate if the concentration of HIV in the mother's blood is not "undetectable" during pregnancy. In addition, the mother should avoid breastfeeding her baby to prevent transmitting the virus through her breast milk.

A diagnosis of HIV does not mean you can't have children. But you can pass HIV to your baby during the pregnancy, while in labor, while giving birth, or by breastfeeding. The good news is that there are many ways to lower the risk of passing HIV to your unborn baby to almost zero.

What can I do before getting pregnant to lower my risk of passing HIV to my baby?

If you plan to become pregnant, talk to your doctor right away. Your doctor can talk with you about how HIV can affect your health during pregnancy and your unborn baby's health. Your doctor can work with you to prepare for a healthy pregnancy before you start trying to become pregnant.

Everyone living with HIV should take HIV medicines to stay healthy. If you are thinking about becoming pregnant and are not taking HIV treatment, it is important that you begin, because this will lower your chances of passing the virus to your baby when you become pregnant.

There are ways for you to get pregnant that will limit your partner's risk of HIV infection. You can ask your doctor about ways to get pregnant and still protect your partner.

I do not have HIV, but my partner does. Can I get pregnant without getting HIV?

Women have a higher risk of HIV infection during vaginal sex than men. If you do not have HIV but your male partner does, the risk of getting HIV while trying to get pregnant can be reduced but not totally eliminated.

Talk to your doctor about HIV medicine you can take (called pre-exposure prophylaxis or PrEP) to help protect you and your baby from HIV.

You may also want to consider donor sperm or assisted reproductive technology, such as semen washing or in vitro fertilization, to get pregnant. These options can be expensive and may not be covered by your health insurance.

I'm pregnant. Will my baby have HIV?

If you just found out you are pregnant, see your doctor right away. Find out what you can do to take care of yourself and to give your baby a healthy start to life.

With your doctor's help, you can decide on the best treatment for you and your baby before, during, and after the pregnancy. You should also take these steps before and during your pregnancy to help you and your baby stay healthy.

Just because you have HIV doesn't mean your child will get HIV. In the United States, before effective treatment was available, about 25% of pregnant mothers with HIV passed the virus to their babies. Today, if you take HIV treatment and have an undetectable viral load, your risk of passing HIV to your baby is less than 1%.

What can I do to lower my risk of passing HIV to my baby?

Thanks to more HIV testing and new medicines, the number of children infected with HIV during pregnancy, labor and childbirth, and breastfeeding has decreased by 90% since the mid-1990s.

The steps below can lower the risk of giving HIV to your baby:

Step 1

Tell your doctor you want to get pregnant. Your doctor can help you decide if you need to change your treatments to lower your viral load, to help you get pregnant without passing HIV to your partner, and to prevent you from passing the virus to your baby. He or she will also help you get as healthy as possible before you get pregnant to improve your chances of a healthy pregnancy and baby. Don't stop using condoms for STI prevention and another method of birth control for pregnancy prevention until your doctor says you are healthy enough to start trying.

Step 2

Get prenatal care. Prenatal care is the care you receive from your doctor while you are pregnant. You need to work closely with your doctor throughout your pregnancy to monitor your treatment, your health, and your baby's health.

Step 3

Start HIV treatment. You can start treatment before pregnancy to lower the risk of passing HIV to your baby. If you are already on treatment, do not stop, but do see your doctor right away. Some HIV drugs should not be used while you're pregnant. For other drugs, you may need a different dosage.

Step 4

Manage side effects. Side effects from HIV medicines can be especially challenging during pregnancy, but it is still important that you take your medicine as directed by your doctor. Talk to your doctor about any side effects you have and about ways to manage them.

Step 5

Do not breastfeed. You can pass the virus to your baby through your breastmilk even if you are taking medicine. The best way to avoid passing HIV to your baby is to feed your infant formula instead of breastfeeding.

Step 6

Make sure your baby is tested for HIV right after birth. You should choose a doctor or clinic experienced in caring for babies exposed to HIV. They will tell you what follow-up tests your baby will need and when. Talk to your doctor about whether your baby may benefit from starting treatment right away.

Step 7

Ask your pediatric HIV specialist if your baby might benefit from anti-HIV medicines before you know if your baby is HIV-positive or HIV-negative. Research has shown that giving combination HIV drugs to newborns is better at preventing HIV than taking AZT (azidothymidine, an antiretroviral medicine) alone.

Can I take HIV medicine during pregnancy?

HIV-infected pregnant women should take HIV medicines. These medicines can lower the risk of passing HIV to a baby and improve the mother's health.

If you haven't used any HIV drugs before pregnancy and are in your first trimester, your doctor will help you decide if you should start treatment. Here are some things to consider:

• Nausea and vomiting may make it hard to take the HIV medicine early during pregnancy.
• It is possible the medicine may affect your baby. Your doctor will prescribe medicine that is safe to use during pregnancy.
• HIV is more commonly passed to a baby late in pregnancy or during delivery. HIV can be passed early in pregnancy if your viral load is detectable.
• Studies show treatment works best at preventing HIV in a baby if it is started before pregnancy or as early as possible during pregnancy.

If you are taking HIV drugs and find out you're pregnant in the first trimester, talk to your doctor about sticking with your current treatment plan. Some things you can talk about with your doctor include:

• Whether to continue or stop HIV treatment in the first trimester. Stopping HIV medicine could cause your viral load to go up. If your viral load goes up, the risk of infection also goes up. Your disease also could get worse and cause problems for your baby. So this is a serious decision to make with your doctor.
• What effects your HIV medicines may have on the baby
• Whether you are at risk for drug resistance. This means the HIV medicine you take no longer works against HIV. Never stop taking your HIV medicine without first talking to your doctor.

Can I get help paying for care during pregnancy?

If you are pregnant, Medicaid may pay for your prenatal care. If you are pregnant and living with HIV, Medicaid might pay for counseling, medicine to lower the risk of passing HIV to your baby, and treatment for HIV. Each state makes its own rules regarding Medicaid. Contact your local or county medical assistance, welfare, or social services office to learn more. If you are unable to find that number, search your state's department of health.

If you don't think you qualify for assistance, check again. Sometimes states change their Medicaid rules. Under the Affordable Care Act, Medicaid eligibility expanded to cover many more people. Also, you may be newly eligible for Medicaid because of increased income limits for prenatal care and HIV treatment for pregnant women.

You may also access care through the Ryan White HIV/AIDS Program.