HIV serodiscordant couples represent at least half of all HIV-affected couples worldwide. Many of these couples have childbearing desires. Safer methods of conception may allow for pregnancy while minimizing the risk of sexual transmission of HIV. In serodiscordant partnerships with an HIV-infected female and HIV-uninfected male, vaginal insemination of a partner's semen during the fertile period coupled with 100% condom use may be the safest method of conception. 1. Introduction It is estimated that there are 34 million HIV-infected people living worldwide with 68% residing in sub-Saharan Africa and 50% of cases occurring among women [1]. Serodiscordance, in which one person in a couple is HIV-infected and the other person is HIV-uninfected, is a common phenomenon. In a multisite collaborative study across East and Southern Africa, 49% of the enrolled heterosexual couples were HIV serodiscordant. HIV transmission within stable serodiscordant partnerships is thought to contribute substantially to the HIV epidemic in sub-Saharan Africa [2]. In the United States, it is estimated that there are more than 140,000 HIV serodiscordant heterosexual couples [3]. In HIV serodiscordant partnerships where conception occurs, the HIV-uninfected partner has a 1.8 (95% confidence interval (CI) 1.01–3.26; ) increased risk of HIV acquisition in comparison to partnerships where conception did not occur. The majority of HIV-uninfected men and women in serodiscordant partnerships where conception occurs acquire HIV within the six months prior to conception and during the first six months of pregnancy indicating that couples engage in risky practices in order to conceive [4]. The per coital risk of HIV transmission from female-to-male is estimated at 0.0010 (95% CI 0.00060–0.0017) in HIV serodiscordant couples [5]. In the United States, 52% of HIV-infected women in a national probability study reported being in a serodiscordant partnership while 47% of HIV-infected women in sub-Saharan Africa are in stable serodiscordant relationships [6, 7]. Evidence suggests that 20–50% of HIV-infected individuals desire children and this desire for childbearing may lead to unprotected sex and/or nondisclosure of HIV status, which in turn results in an increased risk of sexual HIV transmission [4, 6, 8, 9]. In order to adequately curb HIV incidence, the reproductive desires and intentions of HIV serodiscordant couples must guide prevention interventions. Care for HIV-infected adults should include assessing reproductive goals in the context of the HIV status of one’s sexual partners.
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