Virginia Furner
The Albion Centre, Sydney, NSW
Women with human immunodeficiency virus (HIV) infection in Australia are now choosing pregnancy as a proactive, positive, reproductive option. In addition, some women will be initially diagnosed as having HIV infection during a pregnancy. All with HIV women should have access to all the recommended strategies to prevent mother-to-child transmission of HIV infection. In Australia over the past thirty years, a decreasing number of HIV-infected women have had infants born with perinatally-acquired HIV infection, with no infants being infected in 2016 and 2017 [1] (Table 1), as a result of the established antenatal and postnatal strategies to prevent mother-to-child transmission. Some women with HIV infection may have an unintended pregnancy but only a few will decide to terminate their pregnancy and often this will be for reasons not always directly related to the HIV infection.
A few general comments on HIV infection in women in Australia which may reflect the incidence of women with HIV embarking on a pregnancy:
- Over the period 1993-2022, 940 cases of perinatal HIV among children born in Australia were reported. The transmission rate for the period 2018-2022 was 0.6%, compared to 24.6% for the period 1993-1997 and 5.8% in the period 1998-2022.[1]
- Over the period 2013-2021, the median age (years) of women diagnosed overseas has slowly increased from 33.0 to 44.5, and overall, median age of women diagnosed in Australia increased from 34 to 38 years.[1] In general, notifications among females were relatively stable between 2013 and 2019, followed by a 33% decline between 2019 and 2022 with 85 HIV notifications in 2022.[1]
- As at 2022, an estimated 3,400 women in Australia have been diagnosed with HIV, with an HIV prevalence of 0.03% of all females >15 years of age.[1]
Table 1. Number of perinatally exposed children in Australia who were HIV-positive, 2013-2022, by year of birth
| YEAR | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 |
| HIV positive (n) | 4 | 3 | 4 | 5 | 3 | 2 | 1 | 1 | 0 | 2 |
Source: The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia. Annual Surveillance Report 2023. Sydney; The Kirby Institute, UNSW: 2023.
Table 2. Number of Australian born children perinatally exposed to HIV and proportion HIV-positive by 5-year time periods 1993-2022.
| 1993-1997 | 1998-2002 | 2003-2007 | 2008-2012 | 2013-2017 | 2018-2022 | |
| Perinatally exposed Australian born |
72 | 121 | 129 | 246 | 197 | 175 |
| HIV-positive (n) | 19 | 7 | 12 | 69 | 12 | 1 |
| (%) | 26.4 | 5.8 | 9.3 | 28 | 6.1 | 0.6 |
Source: The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia. Annual Surveillance Report 2023. Sydney; The Kirby Institute, UNSW: 2023.
Women with HIV infection will each have different journeys, which may include one or more pregnancies. Providing ongoing care and support to all women who do embark upon a pregnancy, and providing care to their infants after delivery, remains an extremely rewarding experience we will all face as HIV clinicians.