In addition to stigma and discrimination, HIV discordant couples who desire having children are afraid of infecting their HIV-negative partner.
What would be your suggestion (Counselling/ help) for this kind of couple as a doctor?
This is one question I very much look forward to having someone answer to particularly as it relates to sero-discordant couples in developing countries and where the woman is negative.
You've nicely focused on the basic issues of "stigma" and "discrimination" as they would apply in most all places in the world - some more than others.
Couple counseling for HIV and couples HIV testing in the United States have different considerations, one of which is liability insurance. The significance of research that has been conducted in 'developing countries' has led to a greater reliance on "couples" approaches. Main consideration for most any place would be availability/affordability and linkage to care in relation to medications ("prophylaxis") that would reduce the risk of fetal infection and infection of the discordant partner.
Hello Yanick. Sperm washing is not always available and may be cost-prohibitive. However, it seems safer than relying solely on HIV viral load testing, particularly if the man is the HIV-infected partner. Other options are also broached in the 1st article link below. The second link leads to information on discordance between blood and semen HIV viral loads:
http://www.aidsmap.com/Sperm-washing/page/1044934/
http://www.aidsmap.com/Viral-load-in-semen/page/1322890/
FOR HIV 1 only: Research has overwhelmingly shown that without doubt the reliable and best method of preventing transmission of HIV to the uninfected partner, be it the man or the woman, is to treat the infected partner with the most potent combination of antiretrovirals enabling the infected partner to maintain a sustained undetectable HIV-! viral load. This is one of the basis for the recommendation of treating the infected partner in a discordant relationship, even if by other parameters, he/she doesn't require treatment. This would also be particularly useful in a discordant relationship where pregnancy is desired.
Taking PreP would prevent the HIV-negative partner from being infected by their HIV-positive partner and transmitting to child.
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