Regina* was 27 and expecting her second baby when we met. She was eight weeks along and everything seemed peachy.
Her medical history went well until we started talking about other pre-existing medical conditions. She was hesitant at first, then bluntly stated that she was HIV-positive and had been taking anti-retroviral drugs for five years.
She seemed relieved to have gotten that out of the way, but knowing that I was going to be seeing her for a long time, I did not delve into too many details immediately. We would take one step at a time.
We went through her drug regimen to ensure everything she took was safe, followed by physical examination – she was fit as a fiddle. Having been around doctors for long, she understood the relevance of most of the tests ordered and the need for compliance with her medication, pregnancy supplements, diet and regular follow-up.
Subsequently, Regina blossomed in pregnancy and glowed within and without. By the third trimester I had met her adorable five-year-old, but never her husband.
Whenever he came up in discussion, she smiled and said that he was an African man who did not believe in attending to women’s affairs. However, I did learn that he was HIV-negative.
At 38 weeks of gestation, Regina had a Caesarian delivery and was blessed with a healthy baby girl. She opted to breastfeed her exclusively for six months. The little one was put on anti-retroviral medication to prevent mother-to-child transmission of HIV. They both went home in stable condition.
Ten days later, Regina had a brief and unremarkable review. She needed to get back home with the baby before it started raining.
At her next visit, six weeks after delivery, I finally met the mysterious husband. He said hello and opted to wait in the reception with the baby. Regina was all smiles.
HUSBAND TESTED NEGATIVE
She finally opened up about how she was diagnosed with HIV at the birth of her first baby. What followed were terribly dark days that shredded her marriage and almost took her son.
She hit rock-bottom, both mentally and physically, with long hospital admissions for various illnesses. It took months of treatment, psychotherapy and counselling to get her back on her feet. Through all this, her mother was her strongest ally.
During the dark days, her husband repeatedly tested negative for HIV and this was used against her by relatives, serving to widen the rift in their marriage.
Being young and naïve, she did not have the spine to fight for her marriage. However, when she had given up all hope of reclaiming any semblance of family life, her husband showed up on her mother’s doorstep to take his wife and son home.
They decided to stick together despite being a discordant couple. Regina faithfully attended her comprehensive care clinic and worked hard to maintain her body in peak condition. She ate well, exercised, took her medication, religiously monitored her CD4 counts and her viral loads and kept a positive spirit.
What she never spoke about at her clinics, was her desire to have another baby. She had been robbed of an important period in her son’s life (when he was an infant fully dependent on his mother yet she was not available).
She had a gnawing need to walk that path fully with another baby and this desire grew year by year. However, being a discordant couple who used condoms for protection, she was scared of asking her caregivers how to go about safely conceiving.
Her husband could see how this was tearing her apart even though she wouldn’t talk about it. To help his wife, he fell back on the African man stereotype. He refused to use condoms with her and did not want to be questioned about it.
When she conceived, he resumed condom use without prompting. After the birth of their daughter, he confessed that he would rather get HIV than see her unhappy.
He had taken time to complete his tests and was happy to report that his tests showed he was still HIV-negative. This explained why Regina was a bit flustered at her first visit. She thought she would be reprimanded for getting pregnant by exposing her partner to the risk of contracting HIV.
Their incredible story left me amazed. I couldn’t fathom what deep love would drive a man to take the risk of getting a lifelong disease to grant his wife her one wish. But it also exposed a huge gap in knowledge among this special category of patients, the discordant couples.
How often do we discuss safe conception options?
For discordant couples, the best option offered is use of intra-uterine insemination.
Where the man is the one who is HIV-negative, his sperm is collected and used, leaving him unexposed. In the event the man is the one who is HIV-positive, then sperm from a HIV-negative donor is recommended.
In the event that intra-uterine insemination is not acceptable, accessible or affordable, then the couple is fully counselled on the prevailing risk of possible infection before the following options are provided.
In the case where the HIV-positive partner is fully compliant with treatment and their viral load is undetected, they may have unprotected intercourse limited to three days in the cycle when ovulation is anticipated.
For those where the viral load is elevated despite being on treatment, the partner must concurrently take pre-exposure prophylaxis medication for the duration of unprotected sex and still limit exposure to three days in the cycle.
Research has turned HIV into a chronic disease rather than a cause of death as it was a few years ago. This means that we must appreciate that those with the disease have a life to live, including wanting to be parents. They must not be denied this chance!