There are always free stacks of POZ Magazine at the HIV clinic where I volunteer. It's a magazine primarily for HIV positive people; there are many articles about living with the virus and ads for ARVs. I found this article to be thought provoking:
Mother Plus Child Minus HIV
This article was about Luz de Jesus Roman, a boricua mother of 4 who decided to have a fifth child- despite her HIV+ status. She didn't take the decision lightly and researched what medicines to take and not to take and other measures to prevent mother to child transmission. And there are many things women can do to reduce the chance of transmission. But Luz's situation is different from the many women who discover they are HIV+ while pregnant. She knew she had HIV, knew there was a risk (albeit 2%) and took it anyway. There are ethical concerns about women with a terminal, infectious disease deciding to have children - mainly that they could pass it on the their child and that they may die while the child is still young, thus leaving the child without a mother. But then, modern medicine is reducing the chance that either of those things will happen, so the question is arising: Why shouldn't an HIV+ woman, who can reasonably expect to live another 20 years, give birth to a child, who she can reasonably expect won't contract the virus from her?
But that's in the U.S., in the developed world. There are greater ethical concerns in the developing world. In many cultures, having a child isn't just a personal desire, it's a community and family expectation. Yet, while the pressure to have a child may be strong, the resources aren't there for HIV+ women. The same medicines that will prevent an American woman from passing on the virus to her infant aren't available to all women in Africa and Asia. Neither are c-sections, or safe alternatives to breastfeeding. While we know breastfeeding is a mode of mother to child transmission, we can hardly advise against it if formula feeding with contaminated water is likely to harm the infant faster than HIV. Is it a matter of a woman's right to be pregnant? Is it another case where all the world's women are not equal? Women in developing countries will have to wait years before they can make the informed decision Luz did.