Avoiding infection
	Reproductive rights and choices
	Improving access to contraception
	Abortion
	Getting pregnant

Young people, women and men, need advice about HIV and about pregnancy long before they consider becoming parents.

Avoiding infection

Health workers can play an important role in educating people about HIV/AIDS and how they can protect themselves against infection. This may involve working with teachers, youth groups, women's groups and others, to help people to understand HIV better and find ways to encourage and support behaviour change. Improving women's status in society is also crucial - only then will women be able to negotiate with their partners for safer sex.

Reproductive rights and choices

All women, regardless of their HIV status, should have the right to choose whether and when to have children and how many they would like to have. A woman who knows she is HIV positive needs information about the HIV-related risks of pregnancy for herself and her baby and how they can be reduced. But she must still be free to make her own decision about whether or not to have children, and should be supported in her choice.

Improving access to contraception

In an ideal world, every pregnancy would be a wanted pregnancy. All women and men should have access to safe and reliable contraceptives, which include barrier methods, such as condoms. Condoms prevent sexually transmitted infections (STIs), including HIV, as well as unwanted pregnancy.

Where women choose other ways to prevent pregnancy, they should still be encouraged to use condoms as well, to protect against HIV and other STIs. Couples should also be advised to use condoms to avoid infection throughout pregnancy, breastfeeding and afterwards. Even when both partners are HIV positive, they should still use condoms to avoid other STIs and the possibility of re-infection with HIV.

Many women find it difficult to negotiate male condom use with their partners and more female-controlled methods, such as the female condom, are needed. The female condom is already available in many parts of Africa, but often women find it expensive to buy and difficult to use. Female condoms need to be made more affordable and accessible with better information on how to use them.

Abortion

HIV status should never be used as a reason for forcing a woman to have an abortion. In many parts of Africa abortion is illegal. In places where it is available, an HIV-positive woman may decide to end her pregnancy. If she does, she should be supported in her decision. Any decision must be made freely, without pressure from health workers or family members.

Getting pregnant

Getting pregnant involves a risk of transmitting HIV if either partner has been exposed to infection. Couples trying to conceive can minimise the risk of transmission by only having unprotected intercourse (without a condom) during the few days each month when the woman is most likely to be fertile.

Research is being done to develop vaginal microbicides (chemical substances that can be used in the vagina to reduce transmission of STIs including HIV). It is hoped that some microbicides will prevent pregnancy by killing sperm, and also kill sexually transmitted infections such as HIV. It is also hoped that other microbicides will be developed which will kill HIV and other STIs without killing sperm, so that couples can become pregnant without risking HIV infection. However, it is likely to be five to ten years before any microbicides are on the market.