Can I still have children if I have HIV?

Last reviewed: September 21, 2026

Yes. People with HIV can conceive and have children without HIV. Effective ART, pregnancy and delivery care, and infant preventive treatment have reduced perinatal transmission to 1% or less in the United States and Europe. Sustained viral suppression also prevents sexual transmission during conception. Infant medicines and testing are tailored to risk; there is no single four-to-six-week regimen for every baby.^[1][5][11]

Planning ahead: what to line up before you try

The most useful thing you can do is start the conversation early. The federal perinatal guidelines frame the goal for conception plainly: viral suppression should be sustained before attempting conception — for example, two recorded plasma viral load measurements below the limit of detection taken at least 3 months apart — to protect your own health, prevent sexual transmission of HIV, and minimize the risk of transmission to an infant once conception occurs^[1].

Alongside that:

• Both partners should be screened and treated for genital tract infections before attempting to conceive, with rescreening considered based on circumstances and how long the preconception period lasts^[1].
• Starting ART before pregnancy can further reduce the risk of perinatal transmission, and evidence suggests early and sustained control of HIV decreases that risk. Reports are mixed on possible associations between ART and prematurity or low birthweight — a reason to plan with your team rather than to hesitate^[1].
• Care should be coordinated across HIV primary care, obstetrics and gynecology (including reproductive endocrinology and infertility), case management, and peer and social support, with expert consultation when indicated. If conception hasn't happened within 12 months — or sooner based on age or obstetric factors — an infertility workup including semen analysis should be pursued, and earlier evaluation may be warranted given concerns about higher rates of infertility among people with HIV^[1].
• Acquiring HIV newly during pregnancy or lactation carries a high risk of transmitting HIV to an infant — which is why partner testing and PrEP matter throughout the preconception and pregnancy period^[1].

Conceiving when partners have different HIV status

This is where the guidance is most reassuring. For partners with different HIV status, when the person with HIV is on antiretroviral therapy and has achieved sustained viral suppression, sexual intercourse without a condom allows conception without sexual HIV transmission to the person without HIV^[1]. Sustained suppression here means those two viral load measurements below the limit of detection, taken at least 3 months apart^[1]. The evidence base the guidelines cite includes HPTN 052, where earlier ART initiation produced a 93% reduction in sexual transmission among couples with different HIV status^[1].

PrEP is available as an added layer, and asking for it is not a sign of distrust. Providers should discuss PrEP with all sexually active people without HIV, including when trying to conceive; counseling should cover PrEP's benefits for preventing HIV acquisition and perinatal transmission and its potential adverse effects during the periconception period, pregnancy, postpartum, and breastfeeding. When partners with different HIV status attempt conception, the partner without HIV can choose to take PrEP as an additional method even if the partner with HIV has achieved viral suppression, and where suppression is not established or is unknown, PrEP for the partner without HIV is recommended^[2].

CDC says PrEP should not be withheld from a person without HIV who requests it, even when their partner maintains viral suppression. For pregnancy and breastfeeding, NIH’s March 2026 guideline recommends daily TDF/FTC and six-monthly injectable lenacapavir, and says injectable cabotegravir can be considered through shared decision-making. TAF/FTC (Descovy) is not approved for receptive vaginal exposure. PrEP choice should account for health, possible adverse effects, pregnancy plans and required follow-up.^{[12][3][2][4]}

Sperm washing, IUI, IVF: what changed

If you've read older material, you may expect to be sent for sperm washing. That is no longer the default. Federal guidelines state that the use of sperm preparation techniques — "sperm washing" followed by testing the sample for HIV RNA — coupled with intrauterine insemination, in vitro fertilization, or IVF with intracytoplasmic sperm injection, is no longer routinely recommended. The guidelines note that the appropriate role of semen preparation techniques in the current context is unclear, particularly given their expense and technical requirements, and that these techniques largely were developed before studies demonstrated the efficacy of ART and PrEP^[2].

Assisted reproductive technologies may be useful for infertility or for people using donor sperm or a gestational surrogate. When the inseminating partner has HIV, donor sperm from someone without HIV avoids transmission from that partner through conception. Assisted reproduction remains an option based on individual needs and preferences.^[2]

And in the reverse situation — when the person with HIV is the one who will carry the pregnancy and the inseminating partner does not have HIV — assisted insemination during the periovulatory period, at home or in a provider's office, using semen from the partner is an option for conception. It eliminates the risk of HIV transmission to the inseminating partner^[2]. Note that this is a route for protecting the partner without HIV, not a workaround for a detectable viral load; suppression is still the foundation of the plan^[1].

Pregnancy, delivery, and the first weeks

With effective ART and comprehensive perinatal care, transmission during pregnancy and birth can be reduced to 1% or less. Infant preventive medicines are selected by risk; current NIH guidance includes two weeks of zidovudine for low-risk infants and longer or multidrug regimens for other situations.^[11] Without intervention, WHO estimates transmission across pregnancy, labor, birth and breastfeeding at 15%–45%. WHO announced elimination certifications for The Bahamas on April 22, 2026, and Denmark on February 27, 2026. Certification reflects population-level transmission and service-coverage targets; it does not mean every future individual exposure has zero risk.^{[14][15][5][6]}

Delivery planning considers viral load and obstetric circumstances. NIH does not recommend cesarean delivery solely to prevent HIV transmission when ART is taken and HIV RNA is 1,000 copies/mL or less near birth. Vaginal birth may be appropriate; viral load is usually checked at about 36 weeks or within four weeks of the anticipated birth.^[7]

If HIV RNA is above 1,000 copies/mL or unknown near birth, NIH recommends scheduled cesarean delivery at 38 weeks and intrapartum intravenous zidovudine, with individualized expert planning in some circumstances. IV zidovudine is not required when all three conditions are met: ART is taken, viral load is below 50 copies/mL within four weeks of birth, and adherence is established. At 50–1,000 copies/mL, it may be considered case by case; adherence concerns can also change the plan.^[7]

All newborns exposed to HIV during pregnancy or birth should receive appropriately selected ARVs as soon as possible, preferably within six hours. Low-risk infants generally receive two weeks of zidovudine; higher-risk infants receive a risk-based regimen, which may include three drugs. The choice of dolutegravir or nevirapine with zidovudine/lamivudine depends on infant age, gestation, weight and other clinical factors. A birth NAT is recommended for breastfeeding infants and generally for other exposed infants; it may be omitted for low-risk, non-breastfed infants when follow-up is reliable.^[11] Feeding has its own guidance: see our breastfeeding answer.^[4]

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