-With effective use of HAART
ARE YOU IN a sero-discordant relationship whereby you are HIV- negative and your spouse positive? And has the question of having babies proved a challenge to you both, for fear that if you have unprotected intercourse, the uninfected partner will end up contracting HIV? Well, amidst all the red flags, here’s some reassuring news for you:
According to a peer-reviewed  study done by the Department of Infectious Diseases, Hospital Carlos III, Madrid Spain  (first released in July 2006) and appearing in the Journal of the International AIDS Society: 
“The availability of highly active antiretroviral therapy (HAART) has made HIV-infection less of an obstacle to having children for HIV-infected subjects and their sero-negative  partners…The dramatic reduction in risk of sexual and vertical HIV transmission in patients receiving effective antiretroviral therapy (ART) gives support to these desires for having children.”
At the end of a well-balanced study, the report submits:  “HIV-discordant couples seeking pregnancy should receive specialized medical counseling and evaluation.  They should be informed of the risks of viral transmission through assisted or natural reproductive attempts.  If the couple has opted for natural pregnancy, undetectable viremia under HAART is mandatory, and pregnancy is discouraged with patients of any level of HIV replication.”
Used correctly, HAART has been found to bring  the viral load in the blood of a Person Living with HIV (PLHIV) down to undetectable levels (under 50 copies).  As outlined in the study:  “Serodiscordant couples attaining natural pregnancy are exposed to a negligible risk of sexual transmission of HIV when the infected partner presents with complete suppression of plasma viremia while receiving the Highly Active Antiretroviral therapy (HAART).”
That apart, the study also  takes note of  other transmissible infections (i.e. viral hepatitis), co-factors that may increase the risk of HIV transmission or acquisition.  Examples given include:  Disruptions, inflammations, infections, and dysplasias of the genital tract.  It recommends that these should be evaluated within standard protocols.
But on a note of caution, the experts warn:  “It is important to advise these [serodiscordant] couples to restrict overt sexual contacts to fertile days exclusively, for which the use of ovulation tests may be recommended.  Pregnancy attempts should be limited in number, and couples should receive medical reassessment if conception does not occur in three to six months.”
Well, it’s time you begin to talk seriously with your doctor.  If on the first visit you raise the subject with him, and there’s a long line of patients outside his door waiting to see him, be persistent.  If  he tries to dismiss you without answering all your questions, leave nothing to chance.  Make another appointment; go back to him, again and again, until you’re satisfied he has dealt comprehensively with the matter, and answered all your questions.
An earlier study coming out of Kenya found that serodiscordant couples trying to conceive can increase the risk of HIV transmission to the uninfected partner by 80%.  However, many couples within this bracket continue to have unprotected intercourse, in spite of knowing of the possibility of transmission.
However, the bottom line is that People Living with HIV have the right to a pleasurable and enjoyable sexual life, the right to intimacy and freedom of choice as it relates to marriage, having children and planning a family.  
There’s an adage which says that the most powerful sex weapon lies above the neck; that weapon being the mind, caged within the head.  If the state of mind is not right; if there is stress; feelings of fear; feelings of rejection; guilt and uncertainty;  fear of the unknown, during sexual intercourse,  beyond the shadow of a doubt, one way or the other, this could spell ruin for the relationship.  It could result in the sero-negative partner eventually taking flight,  feeling he should do it ‘before it’s too late’  or the sero-positive other, eventually going into deep depression.
Until the experts in the field of virology can come up with another HIV breakthrough, “the availability of HAART, which has made HIV infection “less of  a burden for HIV-infected subjects and their sero-negative partners” will have to be heavily relied on to bring about a dramatic reduction in the risk of sexual and vertical HIV transmission.