Preconception Counseling - Conceiving Safely Partner Safety and Timed Conception - Minnesota Dept. of Health

Preconception Counseling - Conceiving Safely Partner Safety and Timed Conception

Current State: Thanks to advancements in treatments and drug regimens, HIV+ individuals are living healthier, longer lives. Since an HIV diagnosis is no longer seen as a death sentence, many HIV+ individuals desire to start or are starting families. Therefore, HIV providers must ensure that they not only start the conversation but they understand how to have the conversation with both women and men on how to achieve optimal preconception health and conceive safely. The ultimate goal is to increase the number of HIV+ men and women who have been counseled on ways to reduce HIV transmission risks in pregnancy.

Below are a number of resources, curated for you by MATEC, that will guide you through the components of preconception counseling.

1) Important Considerations for Pregnant HIV+ Women

  • AIDS Info
    • 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
    • Critical that providers are aware of and follow all current guidelines in order prevent mother-to-child transmission.

2) Things to Consider in Order to Conceiving Safely for Sero-Discordant Couples

Partner Safety

    Timed Intercourse

    • Resource #1: HIV Negative Female w/ an HIV Positive Male
      (UCSF Division of HIV/AIDS BAPAC)
    • Video simulates a conversation between a patient and their provider
    • Provider is supportive of patient and congratulates her on the decision to start having children
    • Before discussing timed intercourse, makes sure to discuss other things that patient needs to do in order to make this pregnancy safe for patient and her baby:
      • Partner’s health status-ensuring they have an undetectable viral load
      • Prenatal vitamins for the female patient
      • Abstaining from alcohol, nicotine and other drug use
      • Provider walks the patient, who is an HIV Negative Female, through the process of conception, when the best time to try conceiving is and how to identify that time using tools that are available at any local drug store.
        • Encourage patient to keep a calendar so they know when they start and end their period
        • Provider explains relationship between period and the best time to have sex to try and conceive
        • Provider suggests using an Ovulation Testing Kit to know when the best time to try and have unprotected sex is.
        • Using as a Provider Led Activity: Watch the video prior to meeting with patients and use the conversation simulated as a guide for the conversation to initiate with your patient
        • Using as a Patient Led Activity: Have the patient watch the video and then after follow up with questions
    • Resource #2: HIV Positive Female w/ an HIV Negative Male (Source: UCSF Division of HIV/AIDS BAPAC)
      • Video simulates a conversation between a patient and their provider
        • Provider is supportive of patient and congratulates her on the decision to start having children
        • Before discussing home insemination, makes sure to discuss other things that patient needs to do in order to make this pregnancy safe for patient and her baby:
          • Her health status-ensuring she is on the right medications and has an undetectable viral load
          • Prenatal vitamins for the female patient
          • Abstaining from alcohol, nicotine and other drug use
          • Provider walks the patient through timed intercourse and home insemination
          • Timed Intercourse:
          • Encourage patient to keep a calendar so they know when they start and end their period
          • Provider explains relationship between period and the best time to have sex to try and conceive
          • Provider suggests using an Ovulation Testing Kit to know when the best time to try and have unprotected sex is.
          • Home Insemination:
          • Provider suggests using an Ovulation Testing Kit to know when it is the best time to try and get pregnant
          • Partner ejaculates into sterile cup. Use sterile syringe (no needle attached) to pick up the semen and then insert it into the vagina.
          • Could also collect semen from the condom after having sex
          • Using as a Provider Led Activity: Watch the video prior to meeting with patients and use the conversation simulated as a guide for the conversation to initiate with your patient
          • Using as a Patient Led Activity: Have the patient watch the video and then after follow up with question
          • Sperm Washing
          • Where available, sperm washing is one option that couples may consider where the father is HIV-positive. Sperm washing is not currently available in Minnesota.

3) Preconception Care for Women Living with HIV Infection

4) Other resources for review and consideration

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