Six Myths of HIV and Pregnancy for Health Care Professionals to Consider

RAEdiant, BSN, RN

According to amfAR (2021), each week 5,500 women aged 15–24 years old become newly infected with Human Immunodeficiency Virus (HIV). World AIDS Day is on December first. On this day, it's important to recognize that HIV is a viral disease that still has enormous stigma surrounding it. The best way to destigmatize HIV is to educate Health Care Providers so they can educate their coworkers, peers, and patients when given the opportunity.

As a Labor and Delivery nurse, the transmission of HIV from mother to neonate was always my biggest concern. I knew how to protect myself and others from HIV-positive bodily fluids such as blood, lady partsl fluids, and breastmilk but I needed to educate myself on what a healthy pregnancy and delivery should look like for pregnant women with a diagnosis of HIV. In doing this research, I discovered six myths of HIV and pregnancy.

MYTH #1: Babies born to HIV-positive mothers will be HIV-positive

Transmission for HIV requires the viral load of the HIV-positive individual to be greater than 500 copies. Women who have had HIV drug therapy throughout their pregnancy may have an undetectable viral load at the time of delivery. This means the risk for transmission of HIV from mother to neonate is incredibly low. Even women who have not had antiretroviral drug therapy throughout pregnancy can decrease, and even eliminate, the risk of transmission to their newborn with intravenous Retrovir during labor. Both situations require the neonate to receive oral Retrovir after birth to ensure transmission does not occur.

MYTH #2: Pregnancy is dangerous for HIV-positive women

This myth contributes to the stigma that individuals living with HIV cannot live a "normal", healthy life. A diagnosis of HIV does not determine an individual's health status. Most HIV-positive women are able to have healthy pregnancies with the help of routine care from well-informed practitioners and appropriate antiretroviral medications.

MYTH #3: Babies born to HIV-positive mothers will need medication for life

Regardless of the mother's viral load at delivery, most newborns born to HIV-positive mothers will receive oral HIV drug therapy for the first six weeks of life. Infants born to HIV-positive mothers that were not exposed to the virus and therefore diagnosed with HIV, do not need HIV drug therapy after this period.

MYTH #4: HIV meds have negative effects on developing fetuses and newborns

Most HIV drugs, or antiretrovirals, are safe for pregnant women. However, there are some that are contraindicated because of risks to the developing fetus. It is important for these patients to be seen by a provider who is educated in HIV and pregnancy. Studies have shown less risk of transmission to neonates when HIV-positive women have low viral loads from successful antiretroviral therapy prior to becoming pregnant, but that is not a requirement to prevent mother-to-neonate transmission.

MYTH #5: HIV-positive mothers have to deliver via cesarean section

Cesarean section is recommended for women with unknown HIV status or a viral load greater than 1,000 copies. There is no proof that a lady partsl delivery is any more of a transmission risk for HIV-positive women with viral loads less than 1,000 copies. The risk for infection and prolonged postoperative recovery is greater in women with cesarean sections, therefore a lady partsl delivery is preferred.

MYTH #6: HIV-positive mothers will not bond with their babies the same as HIV-negative mothers

Breastfeeding is not recommended for HIV-positive women as the risk of transmission to the newborn outweighs the benefits of breastmilk. Many women fear they will not bond as strongly with their child by bottle feeding. Infants release oxytocin, the bonding hormone, during feedings regardless of the form of feeding. Women should be encouraged to stimulate oxytocin release by performing skin-to-skin contact during feeding and burping of their babies.

As Health Care Professionals, we have a duty to withhold personal judgments and put an end to dangerous misconceptions and stigmas surrounding health. We also must consider that we may not be the best resource for our patients with HIV. There are many tools available to support us and our patients. One example is a perinatal hotline with board-certified practitioners (OB/GYNs, infectious disease specialists, etc.) for pregnant, HIV-positive women within the United States. This resource is available by phone 24 hours a day, seven days a week, and 365 days per year at (888) 448-8765.

References

Statistics: Women and HIV/AIDS

Breastfeeding in HIV

Perinatal HIV/AIDS

Stigma and Discrimination Against Women Living with HIV

Pregnancy, Birth, and HIV