Hospital wants to test me yet my pregnant wife is negative

Dear Doc,

My wife is pregnant, and when she went for her clinic, she was asked to go back with me so that I can be tested for HIV. I don’t understand why I need to do this yet she has already tested negative. Doesn’t that mean that I’m negative too? Why do I need to go for the test?
Dan

Dear Dan,
There are two reasons to have the test done. One is for you to get to know your own status, whether negative or positive. If you test HIV negative, you can adopt risk reduction measures to avoid a new HIV infection. If you test HIV positive, then you can start on anti-retroviral therapy that helps to suppress the virus and reduce the chances of developing opportunistic illnesses. It is not automatic that the HIV status is the same for sexual partners. Both partners may be HIV negative, or they may both be HIV positive, or one may be HIV positive and the other one is HIV negative — a situation called sero-discordancy.
The second reason to get the HIV test is to protect your wife and baby. Pregnancy and breastfeeding are high-risk periods when a number of women contract HIV, and new infection increases the risk of onward transmission to the baby. For this reason, pregnant and breastfeeding women are tested for HIV every six months until they stop breastfeeding. In case you are HIV-positive and are not aware of your status, or if you get a new infection, you can easily transmit the same to your partner, which can also be transmitted to your baby. Knowing your HIV status is important for the sake of your health and that of your wife and baby. Accompanying your wife for antenatal clinic and well-baby clinic later is also a good way to provide support for your wife, and you can also get to interact with the healthcare team and have your own concerns about the pregnancy and the baby addressed.

Dear Doc,
I have been in a relationship with my girlfriend for the past two years. Since she went to college in another town a few months ago, I have been worried. College girls have a bad reputation and I don’t want to get HIV, and I am not yet ready to let her go. Please advise.
Davie

Dear Davie,
There are different approaches to preventing HIV infection. First, it is good to know that HIV can infect anyone, regardless of age, gender, social class, or background. Measures to prevent HIV infection include abstinence, being faithful to one partner who is uninfected, negotiating for and using female or male condoms consistently and correctly, or using PrEP (pre-exposure prophylaxis). PrEP is anti-retroviral medication that you use in advance if you are at high risk of infection or the HIV status of your partner(s) is unknown. 
In case you have an encounter that is a high risk for HIV transmission, you can also take PEP (post-exposure prophylaxis). These are anti-retroviral medications that are taken for 28 days after a high-risk encounter to prevent HIV infection. If there are any sexually transmitted infections (STIs) present, then they should be treated, since they increase the risk of HIV transmission.
For effective HIV prevention, it is good for you and your partner to know your statuses. There are options for being tested in a health facility or getting a self-test kit and doing the test at your convenience, and if either of you tests positive, then you report back to the health facility immediately to start treatment. With HIV treatment, once the amount of virus in the body is so low that it cannot be detected, then the person cannot transmit the infection through sexual intercourse.
Also, it would be good to have a frank discussion on the current status of the relationship, and the expectations from both of you going forward, so that you can have peace of mind.

Dear Doc,

My mum was HIV positive and I got HIV from her. I’m now 23, and I’m in a relationship with someone who is also living positively. I am very scared of getting pregnant because I wouldn’t want my baby to have HIV. How is it possible to get a HIV negative baby in this situation?
Hellen

Dear Hellen,
With the correct measures in place, the risk of HIV transmission from mother to child can be significantly reduced to two per cent or less. For the HIV-negative women, this begins by preventing HIV infection. For the HIV-positive woman, anti-retroviral treatment should be taken as soon as the status is known to maintain good health and being intentional about when you would want to get pregnant. Once you are ready for pregnancy, have a discussion with the HIV care team on the process of prevention of mother-to-child transmission.

As soon as you find out that you are pregnant, visit the clinic for the first antenatal visit. At this time, a blood sample is taken to check how well the virus is suppressed by the antiretroviral medication. This will determine whether the risk of transmission to the baby is high or low. Good adherence to treatment is important to achieve viral suppression, to allow the immune system to recover, to prevent other illnesses and to prevent HIV transmission to the baby. If the levels of the virus are high, then you will be supported in how you take your medication so as to achieve viral suppression as fast as possible.
In addition to use of anti-retroviral medication and regular viral load tests for the mother, there are also preventive medications that are given to the baby from birth to prevent HIV transmission. 
The medications are given from birth, through the entire duration of breastfeeding, up to six weeks after breastfeeding is stopped. In addition, it is very important not to mix the baby’s feeds during the first six months of life: if breastfeeding, then the baby should have breast milk only during the first six months, and then complementary foods are added thereafter. If the mother opts for replacement feeds (infant formula), then the baby should take only this for the first six months, and then complementary feeds are added thereafter. The baby also has several HIV tests done at specified intervals until after breastfeeding stops.
There are many HIV-positive women who have gone through the process and their children are HIV negative. It would be helpful to engage with some of them to hear their experiences. Most antenatal clinics will have a mother who mentors other mothers through this process, drawing from her own experiences and training.

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