Consultations concerning HIV and pregnancy issues may involve serodiscordant couples or, less often, seroconcordant couples. For these couples, referral to an HIV Specialist for expert consultation is recommended.

In brief, recent studies have provided evidence of the effectiveness of ART in preventing sexual transmission of HIV, i.e., treatment as prevention (HPTN 052 and Partner Study).^{[45, 46]} The reproductive health needs of seroconcordant and serodiscordant couples can, very briefly, be outlined as follows: ^[47]

• For couples in which both partners have HIV infection (extremely rarely, they might have different genotypes, one partner having HIV2), both partners should have attained optimal health before conception. They should have demonstrated sustained full suppression of HIV replication before attempting a pregnancy through unprotected intercourse.
• For serodiscordant couples where one partner has HIV infection and has sustained viral suppression, sexual intercourse without a condom allows conception without HIV transmission (now accepted paradigm of U=U, ie Undetectable = Untransmissible).
• For some serodiscordant couples, one partner may be very anxious to have unprotected intercourse to achieve a pregnancy. In this instance, pre-exposure prophylaxis (PrEP) can be offered, particularly when the male partner has HIV or has specific indications for PrEP. If PrEP is used by the HIV-negative partner, it should be continued for at least one month after conception is achieved and revisited throughout the pregnancy if there is any ongoing risk of seroconversion during pregnancy.
• Concerned couples can also be counselled that unprotected intercourse can ideally be limited to the 2-3 day window at the time of ovulation and counselled re strategies to identify the time of ovulation. ^{[48, 49]}
• For serodiscordant couples, if needed, an alternative safe option of donor sperm followed by artificial insemination or in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) may be considered. In the past, sperm washing was available. However, this had very limited availability at the time and is no longer recommended.
• Finally, access to assisted reproductive technology (including IVF/ICSI) should be accessible for all couples as required, to address female and male infertility issues.

In conclusion, the current models of care for couples with HIV infection should encompass integrated HIV, obstetric and paediatric care, contraception when required, and integrated care for couples, which includes early access to treatment as prevention, PrEP if required, and access to interdisciplinary care.