What Works for Women and Girls

A 2008 review of the global literature on gynecologic issues for HIV-positive womenfound that there is a 4.3% probability of transmission within HIV-positive couples tryingto conceive using timed intercourse (timing sex without condoms when the woman ismost fertile in order to increase the likelihood of pregnancy). Viral load should be undetectable,STIs should be treated and ovulation predictors should be used to accuratelytime sexual contact. However, “there are very little data on which to based recommendationsto the HIV-positive seroconcordant couple” (Cejtin, 2008: 726). (Gray V) (treatment,pregnancy)3. Self-insemination can minimize the risk of transmission to partner and infant when awoman is HIV-positive and her partner is seronegative.When HIV transmission to the male partner is to be avoided, self-insemination ofejaculated sperm is advised. “…the data on the safety of unprotected intercourse inthe HIV-infected serodiscordant couples attempting to conceive are rather limited…”(Semprini et al., 2008: 374). (Gray V) (transmission, self-insemination)A report in Brazil of three HIV-positive women resulted in two HIV-negative babies anda pregnancy at the time of the report at the Mexico IAC in 2008. All partners were testedfor STIs. The couples were instructed to have sexual intercourse with a condom withoutadditives during fertile period. After ejaculation into the condom, they collected semenin a cup, put the semen in a syringe and injected it slowly into the vagina without air,near to the cervix. Women then remained with their pelvis elevated for half an hour withminimal movement. Two of the women were on HAART; the other received HAART forPMTCT (Andrade et al., 2008). (Abstract) (self-insemination, HAART, Brazil)4. Sperm washing may be used for an HIV-negative woman wishing to become pregnant withan HIV-positive male partner without acquiring HIV herself.A study in Thailand of 73 serodiscordant couples, where the man was HIV-positive andthe woman was HIV-negative, using sperm washing resulted in a pregnancy rate of over12% with all pregnant women continuing to test HIV-negative (Pankam et al., 2008).Sperm washing isolates HIV-1 free spermatozoa tested for the presence of HIV anddifferent assisted reproductive techniques can be used, such as intrauterine insemination.No cases of seroconversion were shown in 4,000 cycles of sperm washing (Bujanet al., 2007; Barreiro et al., 2006 cited in Coll et al., 2008). (Gray III) (serodiscordant,sperm washing, pregnancy, Thailand)A study in Italy from 2001 to 2003 with 43 couples with seropositive male and seronegativefemales where sperm samples were washed and used for fertilization resulted ina pregnancy rate of over 51%, with no seroconversion detected (Mencaglia et al., 2005).(Gray V) (sperm washing, Italy)218 CHAPTER 9 SAFE MOTHERHOOD AND PREVENTION OF VERTICAL TRANSMISSION