The positive impact which anti-HIV therapy has had on the health of many people with HIV, and the availability of effective means of reducing the rate of mother-to-child HIV transmission, may have encouraged some HIV-positive women to reconsider decisions about sex and relationships, and about having children. If you would like support thinking through these issues, it may be helpful to see a counsellor, or to talk to other HIV-positive women. One option is Positively Women, a national organisation providing peer support to HIV-positive women and their children (tel 020 7713 0444). Another option is Body and Soul, a self-help organisation which supports women, heterosexual men, children and families living with or affected by HIV (tel 020 7383 7678). Alternatively, try calling THT Direct on 0845 12 21 200 - they’ll be able to tell you what services are available near you.

In the UK, HIV treatment centres and sexually transmitted infections (GUM) clinics offer condoms free of charge. The National Health Service (NHS) provides free access to contraception, that is, you do not need to pay a prescription charge. Contraception is available from General Practitioners (GPs), and from Family Planning Clinics. Details of local Family Planning Clinics are available from NHS Direct (tel 0845 46 47).  If acondom breaks during sex, emergency contraception is available to buy from chemists.  You may also be able to obtain free emergency contraception from a GP, GUM clinic or the Accident and Emergency department (A&E) of your local hospital. If your partner is HIV negative and a condom breaks during sex, they should visit a GUM clinic or A&E department within 72 hours where they may be prescribed Post-Exposure Prophylaxis (PEP), a short course of anti-HIV drugs which may be able to prevent them from becoming infected.

You cannot join a clinical trial looking at the effectiveness of new HIV drugs if you are pregnant or thinking of becoming pregnant. See the booklet, clinical trials in this series for more information.

Planning to get pregnant when you have HIV

If you are pregnant, or planning pregnancy, it's very important that you tell your doctor so that they can help you reduce the risk of your baby being infected with HIV and ensure your drugs are the best ones for pregnancy.  Folic Acid supplements and a healthy  lifestyle will be recommended.

Becoming pregnant where one partner has HIV will require ‘alternative’ methods if the negative partner is to be protected from infection. An HIV-positive woman with an HIV-negative male partner may choose to conceive using an insemination method that introduces the semen into her vagina without intercourse, e.g. via injection (most family clinics can supply kits to help with this). An HIV-negative woman with an HIV-positive male partner may wish to pursue a technique known as ‘sperm washing’ which separates the sperm from the seminal fluid, which is where the virus is found. The “washed” sperm can then be injected into the woman when she is ovulating. Currently, sperm washing is not widely available in the UK and individuals often have to pay for this service. Involving your doctor and healthcare team in your plans is likely to be very important, particularly if you are taking anti-HIV therapy.

Contraception

Contraceptive choices need to be made on an individual basis. Although condoms are highly effective at preventing pregnancy, the transmission of HIV and most sexually transmitted infections, they have to be used properly to work. You may therefore wish to consider a back-up form of contraception, in addition to condoms. Of the alternatives:

• The Mirena Coil includes hormones that reduce the risk of heavy periods and anaemia and frequently stops periods. Before the coil is fitted, you will be offered a sexual health screen and be given treatment with antibiotics if you have an infection. It can be easily removed if it doesn't suit you. The coil is also used by women with heavy painful periods as an alternative to hysterectomy

• Protease inhibitors reduce blood levels of the oestrogen component in oral contraceptive pills, so women taking both the contraceptive pill and protease inhibitors will need to use back-up methods of contraception.

A number of other medications (e.g. antibiotics) interact with hormonal contraceptives, so getting advice on drug interactions from your HIV doctor or pharmacist is important. During the period you are taking any antibiotics, and for a week after, you are recommended to use an additional form of contraception.