• HIV
• infertility
• reproductive technology

Infertility centres are increasingly dealing with couples with HIV who strongly want to be parents.¹ Preconceptional counselling and reproductive assistance for such couples have significant ethical and practical implications for the couple and the carers. This article addresses the ethical and practical issues concerned in assisting them to limit negative consequences, both for the couples and the future child.

In general, there are four underlying principles that constitute the framework of medical ethics:

1. Primum non nocere: first of all, do no harm

2. Beneficence: do good

3. Autonomy: respect the individual

4. Justice: honest and fair care.

Thus, these principles of medical ethics stress the need to do as much good as possible while keeping the harm/risks of any intervention to the minimum. To respect the patient’s autonomy, they need to be informed of the diagnosis and management options (pros and cons) in terms they understand and be allowed to make choices for their care without undue pressures from carers. Finally, the treatment must be administered in a just and fair manner.²

We present three clinical scenarios of couples demonstrating the dilemmas faced in the management of these situations.

1. The man is infected with HIV and the woman is not

2. The woman is infected with HIV and the man is not

3. Both the man and the woman are infected.

When these couples are fertile (for example, they have conceived spontaneously in the past) medical intervention aims at reducing the risk of viral transfer to the uninfected partner and the future child. This does not pose a substantial ethical problem, although those against these couples conceiving can argue that providing preconception counselling may encourage them to conceive, thus posing a risk for the uninfected partner and/or the child and that this risk would not be present otherwise.

In couples who have already …