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A Closer Look: Q&A with Olivia Ford

Olivia FordOlivia Ford is the executive editor for TheBody.com and TheBodyPRO.com. She recently wrote a piece titled, “Can HIV-Positive people People Have Babies? 7 Myths About Pregnancy and HIV/AIDS” for a Spotlight Series of resources on the topic of pregnancy and HIV/AIDS for TheBody.com.

What are some of the common myths about pregnancy and HIV/AIDS? 

Well, a persistent myth, or piece of misinformation, about pregnancy and HIV/AIDS is that women living with HIV cannot have babies, or at least not HIV-negative babies. Before effective HIV meds were available, about 25 percent of babies born to mothers living with HIV were HIV-positive. Not only is this no longer true, but here in the United States we’ve actually got that likelihood down to as low as less than 1 percent by CDC’s last count. Remember, though, these miraculous outcomes rest largely on rigorous prenatal care — ideally by providers experienced with treating pregnant women living with HIV — and effective HIV treatment, which means treatment that’s able to drive the virus down to undetectable levels in a person’s body. Speaking of effective treatment and undetectable viral loads, another misconception drawn from earlier days of the HIV epidemic is that women living with HIV have to give birth via Cesarean in order for their babies to be protected from HIV infection. In those earlier days, HIV docs couldn’t get viral loads down to safer, undetectable levels — the existing meds back then didn’t do it — so C-section was used to keep babies from being exposed too long to their moms’ bodily fluids during labor and birth. But now that so many women are giving birth with undetectable viral loads, that’s much less of a concern. The current recommendation for a woman living with HIV is a vaginal birth, but only if her viral load is below 1,000 by the time her baby’s ready to be delivered and there’s no other medical indication for C-section.

How have advances in treatment supported HIV-positive mothers in having healthy pregnancies and babies?

The ability to get viral loads down to undetectable has much to do with current medications being relatively easy to access (though in the U.S., we still need to get better about making meds available to all who need them), easier to take (fewer pills), and easier to tolerate (few to no side effects). The fact that HIV testing for pregnant women has become standard in the U.S. has played a large role in reaching women who might not otherwise be tested or get into HIV care. However, the drawback to diagnosing so many women while pregnant is, well, they’re being diagnosed with HIV (huge life-changing event!) while pregnant (also a huge life-changing event!). Wouldn’t it be ideal to have a chance to learn to cope with the former for a bit, before taking on the latter, instead of experiencing both in tandem? The next big hurdle, to my mind and that of many advocates, is to better integrate HIV testing into primary care, and HIV testing and services into reproductive health services before a woman becomes pregnant. It’s been CDC’s recommendation since 2006; time for the majority of U.S. providers to get on board!

Is there any evidence that a mother’s HIV medication has longterm effects on her baby?

As of now, no – except for the drug Sustiva, which has been shown to cause birth defects in a modest number of cases. Since 1994, the Antiretroviral Pregnancy Registry has been monitoring the children of women who took HIV meds while pregnant and found no evidence of significant long-term effects. Remember, though, the registry is voluntary and a woman needs to register through her provider, so if the provider isn’t aware, the woman and her children won’t be part of the registry. It does not monitorevery birth involving HIV meds in the U.S.

One of the myths you debunk is that “HIV-positive men can’t safely be biological fathers.” How has HIV treatment made it increasingly possible for men to safely father a child?

In 2011 we got some phenomenal news in the HIV community. A big study found that, with effective treatment and an undetectable viral load, the chance that an HIV-positive person will transmit HIV to his (or her) HIV-negative partner can be reduced by up to 96 percent — thus furthering the concept that HIV treatment has a role in HIV prevention. This was a promising development for HIV-positive men having babies “the old-fashioned way,” through sex with women, though treatment guidelines still recommend consulting with a provider, and timing sex for conception to happen when a woman is most fertile to reduce risk. There’s also aprophylactic pill recently approved by the FDA for HIV-negative people at high risk for HIV that may be taken before an exposure for further protection; but again, find a provider who knows HIV, and talk it through with him or her! Procedures like sperm washing have also existed for years to reduce risk of HIV transmission during conception when the papa is positive, but prices of these may be prohibitive for many.

How will health benefits change for HIV-positive pregnant women with the implementation of the Affordable Care Act? 

HIV and pregnancy are alike in the realm of health insurance in that both have in the past been considered “pre-existing conditions,” and therefore grounds to deny a person health coverage — or overcharge them for the coverage they’re offered. In the year 2014, when a host of provisions of the U.S. Affordable Care Act will go into effect, this will no longer be the case for either HIV or pregnancy!

Is there any additional advice, information or resources you want to share with clinicians and practitioners?

My advice for providers who are not HIV specialists — as a community member and information purveyor and not a clinician — would be to do your research, especially if you have a patient who’s living with HIV. Check out TheBody.com’s section on pregnancy and HIV/AIDS for great information that could be of use both to you and your patients. We also have a sister site especially for medical professionals, TheBodyPRO.com, with its own more clinically focused pregnancy information. HIV treatment guidelines (and there are separate ones just for pregnancy) change at least once a year, often significantly, so don’t assume what you know from the last article you read a few years back is the most up-to-date knowledge. And if you do have a patient who’s positive, and you feel like your HIV knowledge could use some support, there’s always co-management — find a provider who’s knowledgeable about HIV, work with and learn from that person! It’s unbelievable the hoops some people have to go through sometimes just to get their providers to test them for HIV — and these are people who know to ask. Do what you need to do as a provider to learn to feel comfortable administering HIV tests and delivering HIV test results, and then start offering those tests. Then tell a provider friend! You’ll be chipping away at the biggest, most dangerous barrier to ending HIV in the U.S. and the world: stigma!

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