Featured in the June edition of the Journal of Obstetrics and Gynaecology Canada is a new clinical practice guideline to help doctors, nurses and midwives assist HIV-positive individuals or couples with their fertility and pregnancy planning decisions.
People with HIV are now living longer and healthier lives than they were even a decade ago. This is mostly due to advances in medical treatments, such as the development of combined antiretroviral therapy (cART). With this change in life expectancy and quality of life has come an increasing number of pregnancies for HIV-positive Canadians.
For many years we have understood how to substantially decrease transmission of HIV from mothers to their babies and this information has helped fuel recent developments showing that HIV treatment can reduce transmission between partners (‘Treatment as Prevention’). In fact, the use of cART, selective choice for Caesarean section, as well as a decision to abstain from breastfeeding, all help drastically reduce the chances of HIV transmission from mother to baby.
While HIV-positive individuals or couples may have new options to consider in terms of family planning, they often bear the burden of additional psychosocial and mental health problems because of the stigma associated with the condition and the risks of HIV transmission.
“There was a time when it was considered impossible, or at the very least, unacceptable for HIV-positive parents to consider having a child. Such views are no longer accurate or appropriate today, particularly when conception and pregnancy are handled responsibly,” said Dr. Mark Yudin, one of the principal authors of the new guideline and chair of the SOGC’s Infectious Diseases Committee.
This new guideline provides health-care professionals with the clinical information and recommendations they need to assist HIV-positive individuals and couples with their fertility, contraception and pregnancy planning needs. This document supports the World Health Organization’s statement that “all couples and individuals have the right to decide freely and responsibly the number and spacing of their children and to have access to the information, education and means to do so.” People living with HIV or AIDS should be no exception.
These patients need extra support to help them effectively manage the additional fear and stress they may be experiencing. They also require acess to pregnancy planning and fertility services. Regretfully, access to these services in Canada was scarce, but this has improved in recent years, and their reproductive health concerns are now receiving more attention.
Dr. Deborah Money, also a principal author of the guideline, expressed the following: “With proper planning, it is possible for HIV-positive Canadians to have a healthy baby. While there are a number of special considerations unique to an prospective mother with HIV, there are a number of preconception, contraception and fertility recommendations that remain the same as they would be for any other woman.”
While the SOGC is pleased to have published this guideline focused specifically on pregnancy planning for HIV-positive Canadians, it is important to note that the Society is now devoting efforts to the completion of a clinical practice guideline focused on the management of HIV in pregnancy.
Source: Journal of Obstetrics and Gynaecology Canada