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Siyayinqoba Beat It! Episode 24 -

Pregnancy and HIV

This week we were looking at pregnancy and HIV on Siyayinqoba. We talk about the safest ways for HIV positive couples to have children or if you or your partner is HIV positive. What you can do if you are HIV positive and your partner is negative. We visit the Cape Fertility Clinic and talk to Dr Linda Gail-Bekker about the risks of having a child if you are HIV positive and safe ways to conceive. In studio the support group are joined by Dr Nombuso Mthethwa to discuss pregnancy and HIV.

Shalom Ncala: Sanibonani siyani amukela iqenjeni leSiyayinqoba Beat It! igama lami ngingu Shalom Ncala. Eqenjeni loSiyayinqoba Beat It! sonke siphila kahle neHIV. Sanibonani nonke. Ninjani kodwa namhlanje. [Hello and welcome to the Siyayinqoba Beat It! support group. My name is Shalom Ncala. In Beat It! support group, we are living positively with HIV. Hello everyone. How are you?] Each week, we get together to talk about issues that affect our lives, from sex to a positive person to over come stigma and denial. USiyayinqoba nguhlelo lwakho lokhu phila kangcono nge HIV.Uma uphila negciwane le HIV, noma unomlingani, ilunga lomdeni noma umngani ophila negciwane leHIV iSiyayinqoba ye yakho. Kuleli viki sebheka ukuzethwala ne HIV. ISiyayinqoba ithole izincwadi eziningi ezimaxondana ngalesi sehloko. Ababukheli bethu bafuna ukwazi ukuthi bangabanozo izingane ngokuphepha uma baphila ne HIV. {isiZulu} [Siyayinqoba is your guide to better living with HIV. If you are living with HIV or you have a partner, a family member or friend who is living with HIV, Siyayinqoba is for you. This week we are looking at pregnancy and HIV. Siyayinqoba has received many letters on this topic. Our viewers want to know how they can safely have children if they are living with HIV.]

Questions: If me or my partner is living with HIV, what is the safest way to have children?

Shalom Ncala: Isivakashi sethu esiqavile namhlanje ngu Doctor Nombuso Mthethwa ongu dokotela wokhubelethisa nowezifo wesifazana esibhehlela I King Edward eThekwini. Siyakuamukela dokotela. Kanye futhi sithanda ukuamukela uNokhwezi Hoboyi.Sawunona Nokhwezi. Unjani ma? U Andile Madondile eKhayelitsha uphila ne HIV futhi unesifizo esikhulu sokuba nezingane. Igembu leSiyayinqoba lamulandela emthola philo e Kapa wokuwandisa inzalo, alpho udoctor Le Roux wachaza iqube yokugeza isidoda nokuthi agaba nengabe kanjani kuphephile? {isiZulu} [Our special guest today is Dr Nombuso Mthethwa, an Obstetrician and Gynaecologist at King Edward Hospital in Durban. Welcome doctor. We would also like to welcome Nokhwezi Hoboyi. Welcome Nokhwezi. How are you? Andile Madondile in Khayalitsha is living with HIV and desperately wants to have children. The Siyayinqoba team followed him to the Cape Town fertility clinic where Dr Le Roux explained the process of sperm washing and how he can have a baby safely.]

Cape Town, Western Cape, ‘I want to have a baby even though I’m living with HIV’

Andile Madondile: Igama lami ndingu Andile Madondile ndihlala apha eKhayelitsha e Site B kwa SM 63. Ukuqala kwani ndandi gula kakhulu go 2004. ndabheka eclinic. Qabafumaniseka ndi HIV positive, Ndiyarhalele ukuba nabantwana kodwa ke eyona ingxaki iyi one because of ndiyazi icherie yami ayiphili ne HIV so long because usatest HIV negative yena. So kengokhu kunzima ndinga haver isex without icondom uyaqonda.Kuthwa ku expensive ukuyeza kwalahlobo whereby kuthathwa khona isiperm sakhatata sithathwe siyofakwa egandeni likhamama without ukuthi thina siye sandibana ngokwe sex thina sobabili negabane lami. Nxa kuthwa khuduri kakhulu kakhulu,ndiyarhalela ukuba nomtwana kakhulu kakhulu ukubanomtwana ikangakhumbi ngoku ndi HIV positive lento leya indixelela ukuba nam ndizaba responsible uyaqonda. {IsiXhosa} [My name is Andile Madondile and I stay in Site B, Khayelitsha, SM 63. In 2004, I was very sick. I went to a clinic, and they found that I am HIV positive. I wish to have children, but I have one major problem. My girlfriend is not living with HIV. She always tests negative, so it’s not easy to just have unprotected sex. I’ve heard of ways of introducing the male sperm to the female egg, without having to have unprotected sex. However, they say it is very expensive. I really want to have a child, especially now that I’m HIV positive. This has made me more responsible.]

Dr Andrew le Roux, Cape Fertility Clinic: Andile, there are options now for somebody who’s HIV positive in terms of having a child. There are techniques that we can use to help you and your wife to have a baby, which make it safe, so that your wife is not exposed or the baby is not exposed to HIV virus. The main technique that we use to make it safe is the man is HIV positive is a procedure called artificial insemination. And that is where we get your sperm sample, and in our laboratory we prepare it in such a way that it’s safe so we can put it inside your wife’s womb and she is not at risk of getting HIV.

Andile Madondile: My CD4 count is 259, is it okay to have a child?

Dr Andrew Le Roux: It’s ideal that the patient has a CD4 count above 200, because it’s more likely that they are going to be able to look after a child in the first place. In terms of sperm washing, we also know that if the CD4 count is lower than that, you’re gonna have more problems preparing a sample. So I would normally advice patients if CD4 count is below 200 they first seek help, medical help with Anti-retrovirals treatment to correct that problem, then they have a better chance of themselves to be healthy to look after the child, and secondly a better chance with the procedure

Andile Madondile: Okay, I just want to know how much does it cost?

Dr Andrew Le Roux: The artificial insemination procedure which includes the laboratory work and the doctor’s fees, and the viral testing and so on, altogether comes to about R3000 for a treatment cycle.

Andile Madondile: Is there any other… For example, my CD4 count is high now is 259, and my viral load is undetectable. Can I have a child without using a condom? Because definitely, for sure I am going to penetrate to my wife or my girlfriend without using a condom if I want a child.

Dr Andrew Le Roux: It’s incorrect. Even if your immune system recovers, there’s always a small amount of virus that circulate and they’ve even done studies where people have very low viral loads, where they’ve had intercourse and found that you can get seroconversion. So it really is not safe, even if your CD4 count is fine. I think if your CD4 count is good, that’s the time that you should start planning a child, perhaps, and going to see a specialist. But you should do it the safe way.

Andile Madondile: Ukuba bendine mali bendinokuyenza lento. Nxa kengoku ingxaki iyi one because kuyanyanzeleka ukuba ndindabane nepartner yami kuqala. Into endiyaziyo ukuthi andinakwazi ndibenamtwana without consulting ugqirha wami uyaqonda. If I CD4 count yakho, even if is high you need to counsult ugqirha {isiXhosa} [If I had the money, I would do the artificial insemination. It’s important that I discuss this with my partner first. Now I know that I can never have a child without consulting my doctor. Even if you have a high CD4 count, you still need to consult a doctor] before you have a… if you want to have a child, because I’m HIV positive you see I might even infect my girlfriend, and my child also… ]

Support Group

Shalom Ncala: Doctor Nombuso into yikuthi in a chances whereby ipartner yami, say maybe umuntu wesilisa utholekhala ukuthi upositive and wesifazane yena unegative. {isiZulu} [Dr Nombuso my question is, in case where one partner say maybe the man is positive and the woman negative.] What other alternatives are there?

Dr Nombuso Mthethwa: Uma owasifazane unegative akanalo igciwane,yikuthi a thole imbewo yomuntu wesilisa semen with the sperm ngikuthi bangahlangani, okuyisito esisetyeziswayo yikuthi bangahlangani, yinto abayibiza nge sperm washing. Buthwathwe ubudoda besulisa kugezekhe igciwane, ngoba ingciwane liba ebudodeni lonke, kodwa ibhewu okuyiyona ehlangana neqanda, mancxane kakhulu amathuba atholakhale analo igciwane ngaloyo dlela uyavikeleka, ngalayo dlela ne ngane layo iya vikileka. [If the woman is HIV negative the available options are artificial insemination, another option is sperm washing. We take the semen and wash it to get rid of the virus, because that’s where the virus lives, but the sperm which comes into contact with the female eggs, has small chances of being infected by the virus. In that way you protect the woman and the unborn child.]

Shalom Ncala: What if two people are actually positive and they want to have a baby. Yini, [what] method do you use to impregnate and …..?

Dr Nombuso Mthethwa: Idlela engiyibalile yekhuqala, yokuthi bangahlangana khokujwayelekile kodwa fanele bakwazi ukuthi ikhona amathuba yokuthi lowesifazane athole mhlabe uhla le gciwane lo wesilisa anolo lomunye anganalo. Kodwa ukuze bavumelane ekusebenziseni leyo ndlela bobabili iziphili zabo. Kusho ukuthi their optimal health, health must be optimal, must be eqopheleni ukuthi umzimba wabo ikahle amasotsha womzimba aphezulu nokwanele licindazeke ngokwanele umakundinga ukuthi kukwenzake. Kuze izinye izidlela engizibalile ukuthi ngcono ukufaka imbewu kowesifanzane bangalangani ngokovelo lokhu okujwayelekile. Usususa I amathuba wokuthi lowesifazane athole leli elinye igciwane mhlambe ilingekho khuye uyabona. {IsiZulu} [They can do it the natural way, but the woman might be at risk of being infected with the man’s strain of the virus. But if they want to do it the natural way, both their state of health must be optimal. They must be extremely healthy, the CD4 count must be high enough and the viral load must be heavily suppressed. There is the other option I mentioned artificial insemination instead of the natural way. With artificial insemination, you eliminate the risk of the woman being infected with a different strain of the virus.]

Lihle Dlamini: Doctor, ngedlela uchaza ngayo ku souder expensive and kungenza ngiyibuze ukuthi as an ordinary person , mhlambe earining just a living wage ngingakwazi ukuthi ngiku affordeder, is it easily accessible through public sector or fanele ngize ngiye kuprivate sector ngibe ne medical aid. {IsiZulu} [Doctor this, sounds very expensive. It makes me wonder as an ordinary person earning just a living wage, can I afford it? Is it accessible through the public sector, or do I need to have medical aid and go to the private sector?]

Dr Nombuso Mthethwa: Kuyiqiniso lokho, kuyimali. Okwamanje a siyinto ayenzakhalayo kwizibhedlela zakarhulumeni nge nxa yokubiza. Ngeshwa umuntu bakhafuna ukuyeziwa lento yitno aziyenzala yona privately. Abangakusiza ngakho uma unenkinga yokukhulelwe wena wesilisa noma wena wesifazana, ungachecka wena wesifazana zonke indlela zokucheckwa lokho kuyayenziwa. Unga checkwa anga checkwa umuntu wesilisa bakwazi ukwenza ukuthi bathathe ubundonda bungezwe nokuthi kuthathwe amaqanda kuwena ahlanganiswe nembewu yesilisa asebuyiswela kuwena lokho akukwazi ukuyenziwa nge nxa yemali. {IsiZulu} [It is expensive. At the moment, it’s not done in the public hospitals because it’s expensive. Unfortunately, one has to go to the private sector to access this service. They can only help if there are fertility problems. They can do all the necessary checks, on both man and woman. What they can’t do is sperm washing and artificial insemination. They can’t because of the price.]

Vuyani Jacobs: If my partner and me are having HIV, we both HIV positive , he is on his second regimen which means I’m exposed the first line and my partner she has never started Anti-retrovirals drugs then how do they plan to have a baby: Do you think my partner would then take triple therapy? Would she then use the regimen I am using, or would she use the first line?

Dr Nombuso Mthwethwa: If your partner akakaze afakwe ku treatment, she, fanelwe a assesswe nge merit yakhe naye, of cause the best way to do it yikuthi a testwe yena ukuthi she is infected what is her strain, so it will be wrong to go to her with big guns kuqalwe ngesecond line angazwe atryiwe na nge first line. {IsiZulu} [If your partner has never been on treatment, she must be assessed on merit. The best way to do it would be to test her and check what strain she’s infected with. So it would be wrong to start her with second line without trying the first line.]

Shalom Ncala : I partner yami I negative ne, mina ngi positive. I viral load yami ngiyayazi ukuthi is undetectable and futhi ne CD4 count ia well above 200 it’s 434. {IsiZulu} [My partner is negative, and I’m positive. I know my viral load is undetectable and my CD4 count is well above 200, it’s 434.] Say we ‘take a chance’ and have unprotected sex. What are the chances of him becoming positive due to sexual intercourse without a condom?

Dr Nombuso Mthethwa: Ukuthi uneCD4 aphenzulu kahle une viral load e undetectable but I virus I hlale ikhona ihlala emzimbeni. I chance yokuthi alithole igciwane is always there. Into thini esiye siyibalekhele thina amadokotela ukuthi umuntu umnikeze inumber because imunukhenza ifalse hope. Bangithi khuwe you have 5% with one intercourse is false hope, so mina personally as a clinician I move away from ukunikha inumber because I don’t think inumber carries I value ye risk, ngoba mawuse positive u positive lokho ngeke kutshintshe. {IsiZulu} [There’s always a chance of becoming positive with intercourse which you can’t, even though your CD4 count is high and your viral load undetectable, the virus is still in your body. The chances of him getting infected are always there. As doctors, we try and avoid giving people numbers because it gives them false hope. If I tell a patient that ‘you have under 5% with one intercourse’, it’s false hope. Personally as a clinical, I move away from giving patients numbers. I don’t think the number carries the value of risk, because when you are HIV positive, you are HIV positive.]

Support group Shalom Ncala: Sikhuluma futhi ngokukhulelwa ne HIV emva kwekhefu. Hlala Nathi. {IsiZulu} [We talk more about pregnancy and HIV after the break. Stay tuned.]

Shalom Ncala: Mbukheli siyaku amukela iqenjini le Siyayinqoba Beat It! Uhlelo lawonke umntu ongenwe futhi otithekayo kwi HIV. uNokhwezi Hoboyi washonelwa yizingane ezibili. Ufuna nokhuba nanye ingane kodwa uyesaba. Iqembu le Beat It! laya no Nokhwezi ku doctor Gail Bekker owasinikheza ulwazi ukuthi ungaba nayo ingane ngoku phepha nokuthi amaphi amaARVs ayingozi mawukhulelwe. {IsiZulu} [Welcome back to the Siyayinqoba Beat It! support group. The programme for everyone infected and affected by HIV. Nokhwezi Hoboyi lost two children. She wants to have another baby but is afraid. The Beat It! team went with Nokhwezi to Dr Linda-Gail Bekker, who gave us information on how to have a baby safely and which ARVs are dangerous for pregnancy.]

Can I have a healthy baby If I’m Living with HIV?

Dr Linda–Gail Bekker: So Nokhwezi, what can I do for you today?

Nokhwezi Hoboyi: I’m HIV positive and I would like to have a baby, so I would like to find out how can I go about to conceiving.

Dr Linda–Gail Bekker: I’m sure you are aware that our worry is that women who are HIV infected can transmit the virus to their babies and so that’s really obviously the thing that is in your mind, what we need to talk about. So tell me a little bit about your HIV infection and also about the relationship that you’re in at the moment.

Nokhwezi Hoboyi: I’ve been sick, I’ve lost two babies due to HIV, but I only knew with the second baby that I was HIV positive and though I had a cesaerian delivery with the last one, I breast fed her and then she developed pneumonia at two months, and then she just didn’t get any better, until she passed away at four months, two weeks. Now, I’m in this relationship, though my partner is HIV negative. He knows about my status and we are using protection whenever we’re having sex…

Dr Linda–Gail Bekker: Where at the point now, were you are on treatment for your HIV infection?

Nokhwezi Hoboyi: I’m on treatment for my HIV, because then I was not taking any ARVs. After losing the baby, my CD4 count dropped, it dropped down to 3. And that was in 2004. And since I’ve been on ARVs… my CD4 count is now 309.

Dr Linda–Gail Bekker: What we want in the situation where we are contemplating pregnancy in HIV, the best scenario is a woman who is feeling much better with… virally suppressed and has a good CD4 count ‘cause that gives us the best option for mom’s point of view, make sure that mom’s healthy and strong, is able to cope with pregnancy, because pregnancy is an big demand, but more importantly, if virus is suppressed, if can’t really detect the virus in the body because either you’re on anti-retrovirals or you’re very early in your infection, then there is far less risk of virus being transmitted to the baby, and that really is what we’re hoping for. We want to reduce the risk of transmitting virus from your body into the baby in uterus while baby is still in the womb, critical time what we call peripartum at the time baby being delivered that is the critical time when a lot of virus can transmitted.

Nokhwezi Hoboyi: At the moment I’m at regimen two, I’m taking Tenofovir, 3TC and Kaletra.

Dr Linda – Gail Bekker: Tell you the situtuation with Kaletra is that there isn’t a great deal of information about Kaletra in pregnancy. The most important things are is that we make sure that your haemoglobin is fine, that you’re not anaemic, that your liver functions are fine, and very importantly that your viral load is suppressed. So all of those bloods will need to be taken before you get pregnant to make sure that everything is perfect before you even contemplate getting to a position where you can get pregnant. So we need to make sure that your motivation for having a baby is right and very importantly that your partner is on board. So I would like, if possible, to meet your partner, if that’s okay with you, and have a discussion with him as well.

Nokhwezi Hoboyi: Since my partner is HIV negative and I’m HIV positive, if we want to conceive, should we stop using a condom, or are there any other ways?

Dr Linda – Gail Bekker: Because he’s HIV negative, it means that semen he produces will be non-HIV infected, and therefore what we can do is ask him to produce semen, and then we can introduce the semen into your vaginal passage artificially. So it’s called artificial insemination, and it’s a very simple procedure.

Support group

Shalom Ncala: Ngine experience usisiwami upositive naye usanda ukuthola ingane. Into engigayi qaphela kuye uyewathi mekhaza faller pregnant, i-CD4 count yakhe beyi 600. I hambe ya hamba by the time ashaya u8 month kupregnancy yakhe ibisiyehlile 350 ukuya njalo njalo, That in it self khimi kusho ukuthi i-CD4 count iyayehla kumuntu wesifazane uma u fall pregnant. And ngifuna ukwazi kwi private sector akhona ama interventions ukucendisa umuntu o HIV positive ukuthi a hlale ukuthi a healthy i-CD4 count yakhe ibe normal through out i-pregnancy yakhe? {IsiZulu} [My sister is also living with HIV and she just had a baby. What I noticed with her was that before she fell pregnant, her CD4 count was 600. By the 8^th month of pregnancy, it had dropped to about 350… That to me meant that when a woman is pregnant, her CD4 count drops. Are there any medical interventions in the public sector, to help a person living with HIV to keep their CD4 count stable throughout the pregnancy?]

Dr Nombuso Mthethwa: Pregnancy angicizelele futhi ayiyehlisi i-CD4 count kodwa ibukekha iyehla ethiwa yi dilutional reduction.Ingazi lakho unga khulelwe una about six litres if umntu o healthy onganama problems, kodwa uma ukulelwe u khulelwe ingana iyondwa, singleton pregnancy kuzoba added plus minus litre over what you have. Uma unama twins a bit more, so i-CD4 angithi amacellss akhona in your bloodstream,songoku addeka ngegazi eli extra kuya diluteka. So kubukekha masikhu testwa ipregnancy phakathi nedwawo kuzobukekha kuyehliwe but if kwehlisa yipregnacy yile dilution engiyichazayo fanele ingehli ngedlela ebabazayo significant, unless in your case udado wenu unezinye izinkinga izichallenger I immunity yakhe, yilento engiyishoyo. {isiZulu} [Pregnancy doesn’t cause a drop in the CD4 count, but it causes something called dilutional reduction. A normal person has about six litres of blood, but when you’re pregnant with one child, there will be an addition of approximately one litre. If it’s twins, it’s going to be a bit more. CD4 cells are cells in your bloodstream, and the addition of blood dilutes these cells. So when we test you before and during pregnancy, it’s going to appear as if it’s going down. If the decline is caused by the dilution, it should not be so significant. Unless, in your sister’s case for example, she had other problems that challenged her immune system]

Lihle Dlamini: Doctor since kuqale irollout yama ARVs if wena no partner wakho a both positive {isiZulu} [Doctor, since the beginning of the ARV rollout,] there are a lot of people who have gone on to ARVs, and I see a lot of women who are on ARVs getting pregnant, and I get worried, because I feel that if you want to get pregnant, you should go to a doctor, and [if you and your partner are living with HIV,] and you still want to have your baby the natural way, you should be counselled on it and your partner should know the consequences that they will suffer. What are the risk or consequences of being reinfected with HIV? What are the consequences of that woman getting pregnant without having consulted a doctor?

Dr Nombuso Mthethwa: Njengoba usho nje, I fact yokuthi umuntu ukhuma ARVs does not mena ukuthi your health is optiumum,is the best it can be. Which is way I ideally wakho umuntu akhu planner ukuba pregnant more or so if your HIV positive, ngoba uzoya kudokotela akucounselishe akubone ukuthi ukwesiphi istate. Ithini iCD4 count eyakho ithini iviral namanye nje aba infections, uyazi abantu abane HIV they have other problems mhlambe une TB mhlambe unani, khoke lokho kube tackled before ube pregnant {IsiZulu} [As you say, the fact that a person is on ARVs does not mean that your health is optimum, is the best it can be. Which is why ideally everybody should plan their pregnancy, especially if you are living with HIV. You should go to the doctor and get counselling, check your CD4 count, viral load and other infections, because people living with HIV have other problems like TB. This must be tackled before you fall pregnant.]

Busisiwe Maqungo: Recently bendine casu yomntu wakhe wandifhonela asithi, Busi ndi pregnant, she wa seven month pregnant nxa yendi fhonela, usebenzisa iprivate sector. Uthi imedical aid yakhe makhasebenzise itriple therapy, ugqirha wakhe osebezisane naye because iza redusa kakhulu chance of umtwana makhabe ne HIV and all that. Uthi kendinengxaki ne CD4 count ise high one, okwesibili andikho ready to take I ARVs bacuaes mandingena kwi triple therapy I means it’s a life long thing after I pregnancy. Uthi ke bendi funa ukuthatha noma yi Nevirapine, ndifuna ukuthatha isingle dose therapy, just for i pregnancy ndiyekhe ukuthatha. {IsiXhosa} [Recently, I received a call from someone, saying she is pregnant… She was seven months pregnant. She uses the private sector and she said her medical aid doctor advised her to use triple therapy because it will reduce the chances of her baby being infected with HIV. She says her problem is that her CD4 count is high, and she is not ready to start ARVs, because if she starts triple therapy, it means it’s a lifelong commitment, it won’t stop after pregnancy. She says she would prefer taking a single dose of Nevirapine, just for the pregnancy, so that she can be able to stop it after the pregnancy.]

Dr Nombuso Mthethwa: What you must understand is that everyone who is HIV positive does not need to be put on ARVs. That must be clear. Ama anti-retroviral are drugs which can have very bad severe, even lethal side effects. It can angamubulala umuntu. That is way khuna ma guidelines who needs to be put on. Because sibilance ibenefit ne risk. If umgani wakho lo omufhonelile I CD4 count yakhe is above 400. [ARVs are drugs with can have very bad, severe and even lethal side effects which can kill a person. That is why we have guidelines, as to who needs to be put on ARVs, because we must balance benefits and risk. If the woman you are talking about has a CD4 count above 400,] she should not be put on triple therapy, according to international, even national guidelines, because her risk of side-effects, lactic acidosis and all that, are much greater than the benefit. Awukwazi ukucabanga ukuvikhela kwengane in isolation kumama kuyahambelana. Awukwazi ukhuthi umama njengoba ane CD4 count a above 400 uzovela umufakhe khu triple therapy, she should not be in triple therapy because for her I rick ne benefit azi balancy. Above 350 i risk yelactic acidosis and liver problems is so high, you do not want to know by trying ukusiza mama, imgane u sacrifice umama, that is way I say you cant do one in isolation of the other ziyahambisana. [You can’t consider the child’s health in isolation to the mother, the two go together. The fact that her CD4 count is more than 400 doesn’t mean that she must be put on triple therapy. For her, the risk and benefits do not balance. Above 350, the risk of lactic acidosis and liver problems is so high, trying to save the child, you sacrifice the mother. That’s why I’m saying you can’t do one in isolation from the other, they go together. And then, for her, she can still go on to either dual therapy, whether it’s started at 28, 36 weeks or at minimum a month before, or or a thole isingle therapy, when she goes into labour, or if they have decided to have an elective Caesar, ezonikwezwa I Nevirapine before adeliviswe. Then ingane can still be protected and then the enthuses should be if she wants to avoid akaze acelise umtwana. [she can get single dose therapy, when she goes into labour, or if they have decided to have an elective Caesar, which means she will be given Nevirapine before she delivers. Then the child can still be protected and the emphasis should be, she should not breastfeed her child]. {IsiZulu}

Shalom Ncala: Sikhuluma futhi ngokukhulelwa ne HIV emva kwekhefu. Siyabuya. {IsiZulu} [We talk more about pregnancy and HIV after the break. We’ll be right back.]

Shalom Ncala: Mbukheli siyaku amukela iqenjini le Siyayinqoba Beat It! Uhlelo lawonke umntu ongenwe futhi otithekayo kwi HIV. Namhlanje sifunde ukuthi abantu abaphila ne HIV banekungelu lokhuba nezingane, bayakwazi abesifazane abaphila ne HIV ukuthi bakhulelwe nge phumelelo bese babaletha ngikhu phepha futhi ingane ingathelelekhi nge HIV. Uma uphuza amaARVs futhi inani levirus lengabonakhali egazini lakho amathuba okudlulisela igciwane inganeni macani kakhulu. Abesilisa abaphila nge HIV nabo bangakwazi ukuba nezingane nezihlelo izifana nokhungeza ubudoda. Kubalulekile ukukhumbula qumana no dokotela wakho uma ucabanga ukuba ne ngane. Sibonga zonke izincwadi zenu enizuthumelayo sicela nihlale nizithumela njalo. Siyayijabulela imibono yenu nemi buzo yenu ngakho ke sicela kumniningwane eniyibona ngezansi. Sithemba ukuthi ulijabulele uhlelo lwethu futhi unomoya wo Siyayinqoba sisinke singayohlula. Hlangana nathi futhi evilini elizayo eqenjweni leSiyayinqoba Beat It! Kuze kube yileso sikhathi hlala unephilo futhi unethemba.Salani kahle. {IsiZulu} [Welcome back to the Siyayinqoba Beat It! support group. The programme for everyone infected and affected by HIV. Today we learnt that people living with HIV have the right to have children. It is possible for women living with HIV to successfully fall pregnant and give birth safely to an HIV negative child. If you are on ARV treatment and you have an undetectable viral load, the chances of infecting the baby are very small. Men living with HIV can also father children through procedures such as sperm washing. It is important to remember to consult your doctor, when thinking of having a baby. Thank you for all your great letters. Please keep them rolling in! You can contact us at the address details on your screen now. We hope that you enjoyed the show and the feeling the Siyayinqoba spirit. Together we can Beat It! Join us again next week in the Siyayinqoba Beat It! support group. Until then, stay healthy, stay positive. Goodbye

Question: Go to the doctor if you’re living with HIV and planning on having a baby? Yes or No