5.6. Discordant couples
Couples in which one person has HIV and the other does not are called discordants (FR. discordant — "do not match"). The presence of HIV infection in one of the partners does not mean that they have to refuse sex or relationships.
Discordant couples practice unprotected (without a condom) sex very often. In such couples, the risk of the virus transmission is reduced to zero as long as the infected partner is taking the highly active antiretroviral therapy (HAART) and has an undetectable viral load. This has been proven by large-scale international studies HPTN 052 (https://hptn.org/research/studies/33) and PARTNER (http://www.chip.dk/PARTNER). However, it is important not to forget about sexually transmitted diseases (STDs). Certainly, these infections are treatable, but every new infection puts an additional burden on the immune system, which should be avoided for people living with HIV. Therefore, it is recommended to always use condoms.
The relations of discordant couples have some difficulties associated with the status acceptance, fear of losing a loved one, and the birth of a healthy baby. In this situation, working with HIV prevention organizations can help in receiving timely and quality information. This allows for a normal sex life even in the presence of HIV, as well as conception and birth of a healthy baby.
When discordant couples plan a pregnancy, they should consult specialists (infectious diseases, epidemiologists, obstetricians).
If a woman in a couple has a positive HIV status, she has the chance to give birth to a healthy child without risk for the man to get a virus. Now scientists know how to prevent HIV transmission from mother to child. Women with HIV give birth to healthy children without HIV infection. According to the World Health Organization, the risk of mother-to-child HIV transmission without receiving therapy is 20-45%. If the preventive measures are taken, the risk drops to 1%, and in some countries (Cuba, Thailand, Armenia, etc.) there are no newborns with HIV infection.
In discordant couples where a person living with HIV is a man, there is also the possibility of conceiving a healthy child without the risk of infecting the woman. For this purpose, methods of in vitro fertilization (IVF, ICSI) and sperm purification are used.
It is very important that not only the person with HIV in discordant couples, but also his partner, be screened regularly and followed-up by a doctor.