Being pregnant with HIV
All you need to know about being HIV positive while you are pregnant, and ways to keep you and your baby healthy during this time.
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We hear so much about Aids, yet know so little about the Human Immuno-deficiency Virus (HIV) that causes this syndrome. It’s distressing news when it’s not only your pregnancy test that comes back positive. HIV is a complicated chronic disease that is difficult to understand, yet there are ways of maximising control of this virus while minimising its spread during and after your pregnancy.

If you’ve been told that you’re HIV positive, the first hurdle to clear is telling your sexual partner. He needs to know. If you have several sex partners, they all need to know. That’s the really tough bit. The truth of the matter is that HIV is spread through the sexual fluids, blood and from mother to child.

HIV has no tell–tale signs, and many victims of this cunning human virus are innocently trapped and held hostage by the very act that’s practically essential for procreation and pleasure – sex.

More about HIV

Scientists have made a 3D image of the HIVirus – a virus that is 60 times smaller than a red blood cell. The HIVirus has projections (or spikes) on the outside to help it bind or attach to receptor sites on human immune cells (or white blood cells also called T-helper cells). In this way, the HIVirus can transfer its contents into the white blood cell and uses the host cell (white blood cell) to replicate itself.

Now millions of viruses can be manufactured in the blood. These are then dispatched to body fluids where they can be transferred to other human beings. The level of HIV in breast milk can be high or low depending on the mother’s stage of infection, duration on ARVs and compliance thereof.

Breast milk carries many benefits of immunity against a whole host of infectious diseases, and the Department of Health has said that in circumstances where there is a risk of bottle and water contamination, it is safer to breastfeed than to formula feed babies.

Mixed feeding (bottle and breastfeeding) has been ruled out as a no–no when a mother is HIV positive. Outside the human body, the virus is helpless. It cannot multiply or survive. It is killed by any unfavourable environment and this includes air, water, chemicals, acids, heat and cold. It cannot spread through mosquitoes, flies or dirty toilet seats. That is the good news.

The bad news is that once the virus gets into the body, it will never go away. After the “window” period when the body recognises the virus and develops anti–bodies, it is kept under control by a contingent of white soldier cells supplied by the bone marrow and lymphatic system.

Over time however, these supplies are all used up, and the body succumbs to an immune compromised state of Aids. This means that the body’s defence system becomes so weak, it cannot fight the simplest of infections, and the body succumbs to the complications of any infectious illness.

What happens during pregnancy?

Dr Heinz Wirz from FERMASA (Fertility Mastery Association of South Africa) explains four protective mechanisms against HIV you can use during pregnancy:

Firstly he compares the unfavourable acidic environment of the vagina during a woman’s infertile part of her menstrual cycle that is hostile to sperm survival. “This is also an unfavourable environment for HIV survival, and remains so throughout pregnancy – providing there are no Sexually Transmitted Infections (STI’s)”.

Secondly, the hormones of pregnancy thicken the walls of the vagina creating a strong protective barrier against invading infections and organisms – again, providing there are no STI’s.

Thirdly, there is a protective mucous plug in the cervix (mouth of the womb) that remains fixed throughout pregnancy making it difficult (in the absence of any STI) for HIV to reach the cervix (mouth of the womb) where the virus has access to “receptor” sites or “receptionists” for the virus to gain entry.

Finally, the placenta (when there is no bleeding, injuries or infections) provides a protective barrier against viral transfer to the baby during the pregnancy.

The Wits Reproductive Health and HIV Institute apply and uphold the South African guidelines which promote abstinence and the use of barrier methods (condoms, female and male) to prevent HIV transmission during your pregnancy, so remember to always take these precautions.

How can the virus get to the baby?

Women with HIV have a one in four chance of transmitting HIV to their babies in the absence of intervention. These risks increase when the baby is premature and when there is cutting, tearing, bleeding and other “invasive” procedures during labour and delivery (like monitoring and using forceps).

Doctors and midwives need to minimise these risks by allowing an uncomplicated birth to happen without interfering. When there are complications, a caesarean birth is unavoidable. The risk of HIV transmission in increased when:

  • There is vaginal bleeding before birth, during and after birth.
  • If the placenta comes away from the walls of the womb before the baby is born, or there is difficulty removing it after birth.
  • There are invasive procedures such as foetal scalp monitoring, when water breaks early and labour is delayed or when medical tools are used to assist breaking the water or when forceps or a vacuum cup is used.
  • When an episiotomy (a cut from the vagina into the perineum to increase the size of the vaginal opening) is given during labour.

What can you do now?

Doctors and midwives are trained to counsel and comfort you, to give you hope and ensure confidentiality. You will need time to recover and compose yourself in the consulting rooms before given the chance to ask a few questions.

Don’t feel guilty if you lose your cool or sit dumbfounded and in denial – it happens. Give yourself time to think clearly before making any rash decisions like rushing over to your partner gatecrash his boardroom meeting and shout out the news to the entire company.

This is an action situation however, and you have to get yourself together sooner than later. Blood tests can be taken to determine the viral load (these tests are expensive) and the white blood
cell (CD4) count (this is quite easy and relatively inexpensive).

These numbers are very important because they may influence your treatment, if and how the virus affects your baby, and the type of birth you need to prepare for.

  • High viral load = high risk to baby
  • Low viral load = minimal risk to baby
  • High white blood cell count = good personal immunity
  • Low white blood cell count = poor personal immunity

Maintaining your health

Avoid re–infection

It is essential that a couple be counselled together because you will need to change your sexual behaviour. Unprotected sex (particularly with multiple partners) poses a huge risk for both mother and baby.

Counselling may be difficult to kick–start, but it will certainly open up communication barriers that may have blocked your relationship until now. When your partner has been tested, you need to understand how not to re–infect one another. Therefore, condoms need to be used at all times.

Maximising your health

Any infections that you may have, need attention. You also need to be alert to “opportunistic” infections like flu, thrush or gastro that can quickly are and multiply into a whole host of infections that take twice as long to heal when you are HIV positive.

Lifestyle changes

This means doing all the “good stuff” to keep your body healthy – eat healthily, exercise, quit smoking and reduce alcohol intake and stop all forms of illegal drugs.

Exercise is important, so get out into the fresh air, eat fresh fruit and vegetables and have a positive outlook in life. This may be easier said than done, but getting your status out into the open may clear more obstacles than you realise.

You may be pleasantly surprised by the support you get from family, colleagues and friends – which would be denied if you are hedgy about your diagnosis.

Medication

Anti–retrovirals are recommended only when the virus takes control and practically destroys the immune system. This is because with higher CD4 counts the risks of getting opportunistic infections is lower as the body can reasonably defend itself.

ARVs simply keep HIV under control while the body’s natural immune system gets a chance to recover and increase the number of circulating white blood cells. Anti–retroviral medication has been shown to substantially decrease transmission of the virus to the baby.

Women with a vitamin A deficiency have been shown to be more at risk for transmitting the virus, and although taking a supplement did not necessarily show a decrease in viral transmission – it did play a role in decreasing the number of premature births.

Premature babies are at risk for a higher transmission of the virus. But remember to always take vitamin A on instructions from your doctor, as too much can be poisonous.

Should an HIV-positive mother breast- or formula-feed her baby?

The risk of giving the virus to the baby with breastfeeding is increased from 14% to 29% when the mother is in the advanced stages of Aids and has a vitamin A deficiency.

The risks of transmission are highest in the earliest months of breastfeeding, but the longer a mother breastfeeds, the greater the risk to baby – so mothers in a high risk category are advised not to breastfeed for longer than six months.

Other breastfeeding challenges include cracked nipples or a breast abscess, oral thrush in the baby and mixed feeding (ie breast and formula feeding intermittently at the same time). Both the Department of Health and support groups like the Breastfeeding Forum and La Leché League encourage breastfeeding despite HIV.

They recommend pasteurising breast milk by heating expressed breast milk in a peanut–butter bottle placed in boiled water for at least 10 minutes. In this way, the virus is destroyed without interfering with the good qualities of breast milk.

Educate yourself

The more we understand HIV, the better we can take pro–active measures to outsmart this virus. The first important step is to acknowledge its existence, and the second is to warn sexually active adults (and indeed teenagers) of its cunning strategies. Of all known viruses, it is one that is possible to avoid provided people are educated about HIV. Make use of any resources that you are aware of from your local health clinic to the yellow pages.

Don't be afraid to get help

There are many great organisations in South Africa that will help you through this stage of your life. One of these are SA HIV Clinicians society. It is important that you have the access to support, help and counselling that you need. You can contact them on 011 341 0162 or visit their website www.sahivsoc.org. Your doctor or midwife are also there to support you, so if you have any questions or concerns about your status, don't be afraid to ask them. No question is too small, and the more knowledge you have, the easier it will be to live a healthy life.

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