Your Questions Answered: HIV and Reproduction

By: Jen Sloniger
Your Questions Answered
is a blog series which addresses Project HOPEFUL blog readers’ most burning questions. Please submit your questions to: media@projecthopeful.org

Question: How does HIV affect an adult who is married (and therefore sexually active) to a person who is HIV-? How would the couple go about having a child who is healthy without compromising the health of the spouse who is HIV-?
~Anonymous

ANSWER:
A couple where one partner is HIV+ and the other is negative is called an HIV discordant couple. The good news for discordant couples is that there are options available and child-birthing IS possible for them.

New research shows that early treatment for the HIV-positive partner can reduce transmission between discordant sexual partners 96%

To help us answer today’s questions regarding conception and reproduction our good friend, Linda Walsh, NP, Clinical Director of the University of Chicago Adoption Center shares some information:

To answer the question about conception depends on which partner (woman or man) is infected with HIV as to what strategy will be utilized. Being on a stable ARV regimen, having an undetectable viral load, not having other STDs all decrease the risk of transmission, but do not eliminate it entirely.

There is a technique called sperm washing [for positive men], also artificial insemination is an option [for protection for either a negative man or a negative woman.] And there is some data on doing it the old fashioned way with an undetectable viral load, etc.

Most of my patients, who are young adults/adolescents, have not used the sperm washing technique. All have been young women who’ve had children that are thus far HIV negative. I have no knowledge of any of their partners becoming positive.

Avert.org tells us more about sperm washing:

This involves separating sperm cells from seminal fluid, and then testing these for HIV before artificial insemination or in vitro fertilisation. Sperm washing is a very effective way to protect both the mother and her baby, but it is only available at a few clinics and can be difficult to access, even in well resourced countries.

About.com adds:

Sperm washing is a technique that was first developed in Milan. The concept of sperm washing rests on the premise that HIV resides mainly in the seminal fluid of an HIV positive male. Sperm washing concentrates and separates the fertilizing sperm from the infectious seminal fluid. During ovulation, the woman is then artificially inseminated with the concentrated sperm. Without the infectious seminal fluid, the theory is that the risk of the woman being infected with HIV is greatly reduced, thereby reducing the risk of vertical transmission (transmission from mother to child) as well.In July, 2010 the World Health Organization (WHO) issued new HIV and AIDS guidelines on PMTCT (preventing mother to child transmission) and on HIV and breastfeeding.

According to the 2010 guidelines, all HIV positive mothers, identified during pregnancy, should receive a course of antiretroviral drugs (ARVs) to prevent mother to child transmission. All infants born to HIV positive mothers should also receive a course of ARV drugs and should be exclusively breastfed for 6 months and complementary fed for up to a year.

The risk of transmission from mother to infant without medications is approximately 30%. With PMTCT medical care that number plummets to approximately 1%.

A great resource for learning about comprehensive care is: HIV/AIDS Care and Counseling by Alta van Dyk . You can read the book online HERE

If you’re enjoying this series let us know in the comments below.

New Prevention Research on Breakthrough Microbicide

An interesting article on a new vaginal microbial gel used in studies to reduce transmission of  HIV.

Your Questions Answered: Daily Life

By: Jen Sloniger
Your Questions Answered
is a blog series which addresses Project HOPEFUL blog readers’ most burning questions. Please submit your questions to: media@projecthopeful.org

QUESTION: How do you suggest I go about sharing news with family and friends that we plan to adopt a child with HIV? I shared with my sister (she has two kids) and she seemed very anxious about the idea.
-Anonymous

 ANSWER:
People commonly wonder which approach is best for sharing the news that they plan to adopt a child with HIV/AIDS or other special needs. There is no formula to follow for guaranteed success. But there are some helpful things to consider.

In Person Is Best
This may seem like a given, but, believe me, some people have chosen to share their big news via email, or even had family members
stumble upon their announcement by visiting their blog. This definitely is not the way to go if you want to ensure feelings do not get hurt. If you
plan on disclosing your child’s status you’ll want to make sure the people closest to you know first. Just like you might for any big occasion in
your life, plan to share with your inner circle first, and in person. Sitting down for a talk will give you a sense of people’s initial reaction to your
news and help guide you in determining who might require a little more reassurance about your decision.

Adjust Your Expectations
Though it can be a real bummer, my best advice for parents adopting a child who is HIV+ is not to expect anyone to cheer them on in a big
celebration when they first reveal their plans. Experience tells me that most extended family and friends experience an initial bit of shock upon
hearing the news. Remember, most people haven’t learned anything new about HIV/AIDS since the late 80’s. Given the major lack of education
it’s common for people to have some serious misconceptions. If you enter the scenario confident of your own decision making and determine
to leave some space for your loved ones to digest the facts, and do not require immediate acceptance from them chances are you won’t
experience great disappointment in people’s initial reactions. Tempering your expectations can help you to stay calm when people express their fears and concerns. It’s vital to remember that it took you time to come to the decision to pursue your adoption. It is only fair to give your family the time they need to come around as well.

Ask Questions
It may seem strange, but, sometimes our family members feel insecure about their role in our adoptions. It’s a well known fact most people
don’t like change. When members of our family realize that decisions we are making will bring change to the family structure they sometimes
experience ”interesting” emotions. Not that your family will have the final say in what you decide, but it is important to remember that your
family members have to deal with their own thoughts and feelings on adoption, HIV/AIDS, and disclosure. They will need to consider stigma
and what that might look like for them personally if you do decide to disclose your child’s status.

You can help jump start your family’s consideration of these things by asking them questions. Do your family members have fears/concerns
about the reactions of people around them? How about how others might treat your child? Do they fear for your child being made fun of?
Do they feel insecure about their ability to keep stigma at bay? Are they concerned they won’t have answers to people’s questions? Do they
resent the idea of people being curious about your family and the idea of having to defend your choices to others?

Advocacy Begins Here
I’ve written before that once you decide to disclose you basically sign up to instantly become an advocate. I guarantee you your family will
have questions. By offering them your assistance in finding answers to those questions you have an opportunity to build up your relationship
with them.

Making an effort to provide your family with as much up-front information as possible not only allows you to be proactive but also
lets family members know how much you care about their needs. Family members appreciate knowing they can come any time for more information and that they won’t be resented for it. You don’t have to have all the answers; simply showing a willingness to help will speak volumes
to your loved ones.

After You’ve Done All You Can Do
When we made the decision to adopt a child with HIV, and it was met with some resistance, I made sure I offered my extended family
members as much education information as they needed. None of them had an excuse to be uneducated or remain ignorant. If they wanted
the facts I knew I had done everything within my power to make sure they were readily available to my family; that I’d even made it easy for
them. It paid off dividends. In the end, everyone came around to being supportive.

Unfortunately, it isn’t always the case that everyone comes around. It has been the experience of some Project HOPEFUL families that a few
in their family refuse to accept their adoption because of illogical fears and pure stigma. Flat out, these members of the family would rather
hold on to their fears and ignorance than embrace the child who will be coming home. These are heart-breaking scenarios where the facts
are rejected and adoptive parents’ efforts to educate and inform are shunned. It isn’t common, but if this should happen to you the best advice is to take comfort in the fact that you did all you could. The rest lies in the hands of another. In the end anyone who ignores these wonderful children is the one who misses out on the joy they bring into the lives of all they touch.

I hope these simple tips will help point you in the right direction. Feel free to write us anytime at info@projecthopeful.com.au

Your Questions Answered: Daily Life

By: Jen Sloniger
Your Questions Answered
is a blog series which addresses Project HOPEFUL blog readers’ most burning questions. Please submit your questions to: media@projecthopeful.org

QUESTION: I’m curious what daily life is like for parents raising children with HIV/AIDS. Can you share what it is like?
-Rebecca

ANSWER:
Rebecca, the truth is that daily life for families with HIV-positive children is much the same as any other family. Of course our kids need to take medications, usually twice a day. It is vital for the effectiveness of the medications that they be taken on a regular schedule and that no doses are skipped. Our physician said we are allowed to “fudge” the schedule two times a year. This is because the effectiveness of ARVs depends on them been taken regularly. If they are not the HIV virus could develop resistance and render the medication useless. So, I would say that the main difference in our family’s daily life is planning our schedule around making sure our son always takes his meds on time.

The actual administration of my son’s meds literally lasts only a few seconds. I keep alarms set in my home and on my cell phone to ensure that I never forget. I carry our son’s medications in a travel case if I know we be away from home during the time he takes his medications.

Aside from following universal precautions if there is a blood spill in our home (though, every family should do this as well) the medications are really the only difference.

Our HIV-positive son does go to a few extra doctors appointments per year. He sees a specialist called a PID (pediatric infectious disease) doctor who monitors and treats his HIV. Those appointments are every three months, or four times per year. At every appointment blood is drawn to monitor my son’s viral load (amount of HIV in his body), his CD4 count (this indicates how his immune system is functioning),and checks his liver for any side effects from the drugs.

People often imagine that parents with HIV+ kids are constantly nursing their sickly children. Because my son’s viral load is undetectable and his immune system is functioning normally he isn’t sick any more than my HIV-negative kids. Our son is healthy and strong and growing.

So, that is it. Not much to report, honestly. As I said before, life is pretty much the same for us as it ever was before we adopted our HIV-positive son. Only it is richer and fuller because he is in our family. His virus really doesn’t play into our daily life. What I mean is, HIV isn’t in the forefront of our minds daily. My son is a kid just like any other. He simply has a chronic but manageable disease which he is learning to thrive with.