Having children outside a heterosexual relationship – options for persons living with HIV

Abstract

This article presents information about the social, legal and medical issues that medical and non-medical practitioners in the UK should consider in order to signpost options for people living with HIV (PLWH) who are not in a heterosexual relationship and want to become parents. Despite significant medical advances, increased medical awareness amongst HIV practitioners, and the ability to live a full life with HIV, stigma still exists around PLWH wanting to have children. There is a lack of awareness amongst the general public and the non-specialist medical community, about the realities of living with HIV, and the options available to become a parent. Vertical transmission rates in the UK are very low (<0.5%) [1]. Despite this, even amongst PLWH it is evident that stigma surrounding parenting with HIV is real, with almost 50% of HIV-positive respondents in a European study saying that having HIV would be a barrier to them deciding to have a family [2]. Irrespective of their sexual orientation, HIV-positive parents and prospective parents may bear not only the brunt of an historical HIV stigma, but also the negative discourses that surround lesbian, gay, bisexual or transgendered/gender diverse (LGBT) parenting, despite the legal advances over the past decade. First steps to breaking down this stigma are to increase public awareness around the realities of living with HIV, and awareness among PLWH that being a parent is an option for them. In 2016 in London, the UNAIDS 90-90-90 target was achieved for the first time. England came close to meeting that target, with 88% of those living with HIV being diagnosed, 96% of those on HIV treatment and 97% of them having an undetectable viral load [3]. Most PLWH taking antiretroviral medication therefore have undetectable levels of HIV in blood, meaning they cannot transmit HIV via sexual fluids [4]. Despite this, parenting is not always routinely discussed with PLWH. A recent study in London HIV clinics found that very few clinicians spoke with HIV-positive gay men about the possibility of having children [5]. Misconceptions about HIV transmission risk and medico-legal issues concerning reproduction may, thus, be rarely addressed. Education is also key to challenging stigma, and supporting the medical profession to better advise HIV-positive patients is critical, as a medical appointment is often the first opportunity that people who are newly diagnosed have to think about future options.