Also read about how heterosexual mixed-status couples can have an HIV-negative baby together.
What is a ‘mixed-status couple’?
When one partner is HIV-negative and one partner HIV-positive. Also known as a serodiscordant couple or a serodifferent couple.
Couples HIV testing and counselling
Testing for HIV together and receiving counselling with your partner can...
- Make it easier to disclose your HIV test results to one-another.
- Help you to cope if one or both of you receive a positive result.
- Make planning for the future a shared responsibility.
Read AVERT’s ‘HIV Testing’ fact sheet for more information.
Safer sex tips
Mixed-status couples are able to have safe sexual relationships by following these key bits of advice:1
- Talk about HIV prevention and family planning together as a couple, and with a healthcare professional.2
- Use condoms every time you have sex.
- Consider your HIV treatment options.
HIV treatment for the HIV-positive partner
Antiretroviral drugs lower the amount of HIV in your body.
It can reduce the virus to very low levels (undetectable), making you less likely to pass on HIV.
You can start taking HIV treatment:
- straight away after your diagnosis
- this will lower the virus in your body to prevent transmission your partner.
Seek advice from a healthcare provider about starting treatment.
HIV treatment for the HIV-negative partner
Treatment taken by HIV-negative partners is called pre-exposure prophylaxis (PrEP), and it is recommended for mixed-status couples.3
It prevents exposure to HIV from becoming an infection.4
Access to PrEP is limited so it may not be available to you.
It is important to plan your pregnancy to protect your partner and baby from HIV. Your healthcare professional can direct you to family planning services.
Conception options for mixed-status couples
Having a HIV-negative baby is possible with careful planning.
Your conception options will vary depending on which partner is HIV-positive.
If the female is HIV-positive and the male is HIV-negative
- Artificial insemination protects the male partner from HIV-infected bodily fluids. His sperm is inserted into the woman’s vagina using a syringe. You can do this at home, but with medical advice!5
- Artificial insemination is most effective when a woman is ovulating (releasing an egg). Ovulation occurs about 14 days after a woman’s period starts.
- Ovulation varies between women, seek advice from your doctor.
If the male is HIV-positive and the female is HIV-negative
- ‘Semen’ is the fluid that comes from a man’s penis when he ejaculates (“cums”)
- HIV-infected semen cannot infect your baby, but can infect your partner
- Sperm washing is a procedure that separates HIV-free sperm from the HIV-infected seminal fluid
- HIV-free sperm can be inserted into the woman’s vagina by artificial insemination – eliminating any risk of HIV infection
- Washed sperm can also be used to fertilise the woman’s egg by in vitro fertilisation (IVF)
- Using HIV-negative donor sperm is another option that eliminates HIV risk6
- Access to sperm washing and IVF can be limited in some settings.7
Timed unprotected sex is unlikely to pass HIV to the female partner, if the male partner has:
- undetectable viral load for 6 months
- good adherence to their treatment
- no sexually transmitted infections (STIs).
But this should not be considered without professional advice.
If either one of the partners are HIV-positive
HIV treatment and planned, unprotected sex
Both types of mixed-status couples could take HIV treatment and conceive naturally.
- The HIV-positive partner can take HIV treatment to lower their viral load before having unprotected sex.
- The HIV-negative partner can take PrEP prior to unprotected sex in some cases (however, the risk of HIV infection still exists).
- Get tested and treated for STIs to reduce the risk of HIV transmission.
- Monitor your viral load closely if having unprotected sex.
- Only have unprotected sex whilst the female partner is ovulating.8
- But, unprotected sex still risks passing HIV to the negative partner.
Treatment to prevent HIV transmission to your baby
Test regularly for HIV during the pre-conception, pregnancy and breastfeeding period. All HIV-positive pregnant women should access prevention of mother-to-child transmission (PMTCT) services when pregnant and breastfeeding.
Read AVERT’s ‘HIV and Pregnancy’ fact sheet for more information.
Know your rights
You have the right to:
- request or refuse an HIV test
- refuse HIV treatment
- choose if, how and when to conceive.
- 1. UNAIDS (2012) ‘UNAIDS welcomes new guidelines which give an additional HIV prevention option to serodifferent couples’
- 2. World Health Organisation (2012) ‘Guidance on couples HIV testing and counselling including antiretroviral therapy for treatment and prevention in serodifferent couples: recommendations for a public health approach’
- 3. World Health Organisation (2015) 'Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV'
- 4. AIDS.gov (2016) 'Pre-exposure prophylaxis (PrEP)'
- 5. NAM aidsmap (2014) 'Conception'
- 6. NAM aidsmap (2014) 'Conception'
- 7. NAM (2013) 'Sperm washing'
- 8. The Well Project (2015) 'Getting Pregnant and HIV: HIV+ woman and HIV-negative man (serodiscordant)'