As parents, we must carefully examine these obligations. Our first responsibility is to take care of ourselves, then of the children we now have: the children in our wombs and the children already born. If either of us is sick with HIV-related illnesses, then we must first ensure the wellbeing of these children before considering having further children. If we compared this to a shepherd, we could say that the shepherd must first care for those sheep that already belong to him before obtaining more sheep! In making the decisions about future children, there are specific circumstances that each couple must consider and carefully factor into their decisions: 
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If you do not have access to ARV medications, you are more likely to develop HIV related illnesses and more likely to transmit the HIV virus to future children. If you have access to good HIV care with ARV medications and measurements of CD4 counts and viral loads, the chances of maintaining your health and of preventing mother to child transmission of HIV are improved.
The responsible couple must prayerfully and thoughtfully think about future children, considering of their own health, their responsibility to the children they have and the possible risks of HIV transmission to future children. They may well benefit from the counsel of close family friends, health care providers and their local priest or minister. At this time the couples are asked to reflect on these questions: 1. 2.
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Are we planning on having more children? Why or why not? In our circumstances would we be acting responsibly or irresponsibly if we decided to have more children?