This article by Sean R. Hosein first appeared in CATIE News, an online  publication of CATIE.

Une version française est disponible ici.   

The widespread availability of potent combination anti-HIV therapy (commonly called ART or HAART) has made deaths from AIDS-related infections relatively uncommon in high-income countries such as Canada, Australia and the U.S. and regions such as Western Europe. ART has helped to improve quality of life and tremendously extend the life expectancy of people living with HIV. This has led some HIV-positive people to consider having children.

Safe pregnancies and healthy babies

Today, the risk of mother-to-child transmission (also known as vertical transmission) in Canada is generally less than 1%, thanks to a combination of the following steps:

 • use of ART during pregnancy so that viral load is as low as possible

 • prenatal counselling and care

 • intravenous AZT (zidovudine, Retrovir) for the mother during delivery

 • Caesarean section (when medically necessary)

 • a short course of oral anti-HIV medicines for the baby after birth

 • use of formula rather than breastfeeding (HIV can be transmitted via breastfeeding)

 • not pre-chewing food for the baby when solids are introduced (this can also transmit HIV)

Bridging the gap

As a result of the reduced risk of vertical transmission, more and more HIV-positive women (and some HIV-positive men) are thinking about and having babies. A team led by infectious disease specialist Mona Loufty, MD, one of Canada’s leading researchers, has found that “a gap exists between the desires and intentions of people living with HIV to have children and their need for support in doing so and the resources, relevant research and support networks necessary for them to do so in a medically safe manner.” 

Several studies in Canada and elsewhere have documented that many HIV-positive people would like to have children. Therefore, Loufty and her colleagues note that “specialized counselling, services and support will be required to meet the needs of [HIV-positive people who wish to have a baby].”

Dr. Loufty and a team of researchers across Canada have produced an outstanding document called the Canadian HIV Pregnancy Planning Guidelines to help health care practitioners advise HIV-positive people about issues related to fertility and pregnancy. The guidelines contain 33 recommendations that will assist health care providers and fertility centres to do the following:

 • reduce the risk of HIV transmission from mother to child

 • reduce the risk of HIV transmission from one person to another when people are trying to conceive

 • improve the health of HIV-positive women and their children

 • reduce the stigma linked to HIV infection

 • increase access to pregnancy planning and fertility services

 The guidelines are to the point, highly focused and rich in knowledge essential to producing excellent care and advice for HIV-positive people who want to have a baby.

 Dr. Loufty and her team remind readers that basic general advice for HIV-negative women also applies to HIV-positive women. As such, they recommend the following publications from the Public Health Agency of Canada:

 • Eating Well with Canada’s Food Guide

 • The Sensible Guide to a Healthy Pregnancy

The guidelines deal with many issues related to healthy pregnancy planning and fertility. Some recommendations in the document include the following:

 •“Reproductive health counselling, including contraception and pregnancy planning, should be offered to all reproductive-aged HIV-positive individuals soon after HIV diagnosis and on an ongoing basis.”

 • “Men and women should be counselled on all relevant aspects of pregnancy planning, such as maintaining a healthy diet and lifestyle, the risk of genetic disease occurrence, and integrated prenatal screening, as outlined in current Canadian practice guidelines irrespective of their known HIV status.”

 • “Women with no risk factors should start taking the B vitamin folic acid at a dose of 1 mg a day for three months before becoming pregnant and for at least the first three months of their pregnancy.”

 • “Women should be encouraged to give up smoking, drinking alcohol and using recreational drugs and should be referred for support if required.”

 • “Both prospective parents should be tested for other sexually transmitted infections, even if they have conceived in the past and have no symptoms of infection.”

The guidelines also discuss psychosocial and mental health issues, legal and ethical issues related to pregnancy planning and fertility, and options for reducing the risk of HIV transmission when serodiscordant couples (where one partner is HIV-negative and the other is positive) are trying to conceive.

A highly practical guide

One of the many useful aspects of the guidelines is that they visit scenarios that health care professionals may experience and provide concrete solutions. For instance, the reader is presented with pregnancy planning advice for HIV-positive people in the following situations:

 • an HIV-positive woman and an HIV-negative man

 • an HIV-negative woman and an HIV-positive man

 • HIV-positive single women

 • HIV-positive men or a same-gender couple 

The guidelines also provide advice for fertility clinics. Since such clinics are supposed to be operating under the Canadian Standards Association procedures for universal precautions and infection control, the guidelines state that “there are no scientific grounds on which to refuse services to people living with HIV.” 

Dr. Loufty and colleagues should be congratulated on the Canadian HIV Pregnancy Planning Guidelines. They are a tremendous leap forward in assisting care providers and HIV-positive people to have safe pregnancies and healthy babies. 

Resources

Society of Obstetricians and Gynaecologists of Canada 

Canadian HIV Pregnancy Planning Guidelines 

Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States

Information for Women who are Diagnosed with HIV during Pregnancy

Pregnancy Planning Information for HIV+ Women and Their Partners

Information for HIV+ New Moms

Pregnancy Planning Information for HIV+ Men and Their Partners

This article by  Keith Alcorn originally published by NAM/www.aidsmap.com is republished with permission.

If you have an interest in HIV and have been anywhere near the internet in the last few months, there’s a good chance you will have heard of the 19th International AIDS Conference, also known as AIDS 2012.

The conference is taking place in Washington DC, 22nd to 27th July. More than 20,000 people are expected to attend, but the reach of the research presented at the conference will go far beyond those who are in Washington.

Whether or not you are attending the conference, we’ll be working hard to provide news coverage so you don’t miss out. (You can sign up to receive our free conference emails here.)

Can’t wait for the conference to get started?

Our coverage will focus on five major themes, incorporating research findings reported across all tracks of the conference.

To get you started, we’ve put together a reading list – background reading on the key themes so you can explore recent articles and key resources, on aidsmap.com and on other websites.

Click on the links below for a wealth of information on these important topics.

1. Making the prevention revolution real

Background on:

• HIV treatment as prevention
• Pre-exposure prophylaxis
• Microbicides
• Global Advocacy for HIV Prevention (AVAC resources)

 2. Expanding testing and treatment

 Background on:

• Promoting HIV testing
• Task shifting to nurses
• What will it take to put millions more on antiretroviral therapy?
• Towards universal access (UNAIDS)

 3. Turning the tide for key populations: women, children, MSM, people who inject drugs

 Background on:

• Meeting the needs of MSM in resource-limited settings
• Global Forum on MSM & HIV
• Harm reduction and human rights
• Preventing HIV among injecting drug users (UNAIDS)
• Children (UNICEF resources and Paediatric Treatment for Africa resources)
• Women (GenderAIDS)
• Global Plan Towards Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive

 4. Turning the tide on TB

 Background on:

• TB and HIV
• Improving TB diagnosis
• TB/HIV, mothers and children
• Going beyond the clinic to eliminate TB
• Stop TB Partnership

 5. How can we achieve an HIV cure?

 Background on:

• The search for a cure
• Towards a cure for all
• Towards a cure: how we might do it

For more information

You can find out more about the conference on our conference webpages at www.aidsmap.com/aids2012 and on the official conference website at www.aids2012.org.

copyright © NAM Publications, 2012. All rights reserved

The narrator in Woody Allen’s underrated 2010 film “You Will Meet A Tall Dark Stranger” comes out with a brilliant gem toward the end of the story: “Sometimes the illusions work better than the medicine.” 

While this doesn’t apply to HIV as a biological entity, evidence abounds in our world as to how it fits incredibly well with HIV as a psychological one.  As a friend told me recently, “there is no pill to get people to treat you the way they did when you were negative.” 

Cut to Zimbabwe, where an evangelical pastor has been causing waves for suggesting that Jesus was HIV positive. 

Goodness.  Was he shooting up with dirty needles in a Jerusalem back alley?  Barebacking with Lazarus?  Heavens, is that how Lazarus died? 

Nothing so exciting, I’m afraid.  

Pastor Xola Skosana’s (below right) poz-Jesus gospel fits in well with existing Christian mythology about the son of God bearing the “curses, sicknesses, and punishment of all humanity”. 

The news website ZimEye quotes him as saying: 

“Wherever you open the scriptures Jesus puts himself in the shoes of people who experience brokenness. Isaiah 53, for example, clearly paints a picture of Jesus who takes upon himself the infirmities and the brokenness of humanity.”

Evangelical Christians love that word “broken”. Homosexuals are often spoken of in this manner, whether HIV positive or not – it’s an insidious term that suggests there’s something wrong with us that needs fixing.  

In a biological sense, having HIV is something that we’d all like to fix, but so are cancer and diabetes.  You never hear people living with those illnesses referred to with such patronising fervour. 

But we could forgive being a little patronised if the dialogue ended there.  Skosana, who has lost two sisters to AIDS, was attempting to communicate to religious people in their language to combat stigma. 

And judging by the response of some of his colleagues, we can see what he is up against. This from Pastor Mike Bele at Nomzamo Baptist Church:

“The subject of my Jesus being HIV-positive is a scathing matter. I believe no anointed leader with a sound mind about the scriptures and the role of Christ in our lives would deliberately drag the name of Christ to the ground.

“The pastor needs to explain how it came about for him to bring Christ to our level, when Christ is supreme and is God. There is a concern that non-believers would mock Christ and try to generalise Christ as opposed to the powerful force we believe him to be.”

This is really the point where one has to say enough is enough. 

Decades of this kind of learned shame around sexual behaviour and the realities of being human have fanned the flames of untold misery and premature death, particularly in Africa, where the rise of Christianity surely has to come first on the list of destructive forces wrought by colonisation.

One could argue that religious dogma has done far more damage in Africa, and indeed the rest of the world, than HIV ever could hope to.  A virus can kill people.  Prejudice, ignorance and stigma breaks spirits.

Religious leaders are constantly being urged, from inside and outside the faith, to do more to prevent the transmission of HIV and support those living with it. 

The place to start is not by reaching back into ambiguous ancient scribblings but by dealing with the human beings that are in front of you. 

People infected with a virus are just that – people infected with a virus.  The virus does not know or care about your codes of morality, it has no sentience it all.  Its only function is to replicate.  Death is just a side effect.

I understand what Pastor Skosana and people like him are trying to do.  Many Christians draw strength from the idea of Jesus and their own personal construct of him, based on bits of scripture that they like.

But this is most definitely a case where the illusions do not work better than the medicine.

If you want to speak to your congregation about their health and taking care of each other, remove the supernatural from the equation altogether. Speak to them as one human being to another.

And if you’re going to quote anything philosophical to back up your argument, you need look no further than the Golden Rule – an eternally robust ethic that did not originate with Jesus but was most certainly repeated by him: treat others as you would like to be treated.