By Jennifer Stranges


Dr. Mark Yudin
Dr. Mark Yudin

A new commentary co-authored by obstetricians across four provinces is encouraging pregnancy care providers to lean on Canada’s evidence-based guidelines to support prospective parents living with and affected by HIV.

The commentary, published Monday in alignment with World AIDS Day, comes as people with HIV are living longer, healthier lives and, in many cases, having children. Yet, the authors argue, they often face unequal access to quality, evidence-based pregnancy planning and support.

In offering pregnancy planning counselling to patients with HIV, clinicians should use the Canadian HIV Pregnancy Planning Guidelines, updated in 2018. However, the authors recognize the guidelines can be “daunting and cumbersome.” The commentary, published in the Journal of Obstetrics and Gynaecology Canada, addresses this by offering simple, clearly-written steps doctors can use to help provide quality care to their patients – and honor their reproductive rights.

“By writing this concise, practice-based commentary we hope that pregnancy care providers will see that offering pre-conception counselling for people living with and affected by HIV is very feasible,” said Dr. Mark Yudin, obstetrician at St. Michael’s Hospital and co-author of the commentary.

The commentary is framed around five key considerations for pregnancy care providers in providing pregnancy planning counselling to people living with and affected by HIV:

  1. When a person living with HIV has an undetectable viral load, they cannot transmit the virus to sexual partners.
  2. Condomless sex is safe and recommended for conception for couples living with and affected by HIV when the partner living with HIV has an undetectable viral load.
  3. Access to comprehensive assisted reproductive technology remains a priority for people living with HIV.
  4. Initiating antiretroviral therapy prior to conception is now recommended.
  5. Pregnancy planning care should also include discussing contraception.

The authors say pregnancy care providers across Canada may feel better positioned to offer pregnancy planning counselling to those affected by HIV with an awareness of these key considerations. They also say providing this support is a matter of honoring patients’ rights.

“Access to pregnancy planning support is an issue of reproductive rights for people living with HIV,” said Logan Kennedy, a Registered Nurse and Research Associate at Women’s College Hospital and co-author of the commentary.

“There continues to be disparity in access to comprehensive, evidence-based pregnancy planning support for people living with and affected by HIV across Canada. We are fortunate in Canada to have comprehensive, evidence-based guidelines to support clinicians in offering pregnancy planning counselling.”

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.