For Couples With HIV Positive Partners, Conceiving Requires Risk-Taking
For couples living with mixed HIV status, risk and stigma are unavoidable. The infected partner carries the medical burden associated with their positive status and the uninfected partner must take precautions to prevent transmission. For couples wanting to conceive a child, however, these issues present greater challenges. Fortunately for two families, the parent’s serodiscordant status didn’t stop them from having a healthy, uninfected baby. The stories of these couples are chronicled by author and journalist Heather Boerner in “Positively Negative: Love, Pregnancy, and Science’s Surprising Victory Over HIV.”
The couples, Boerner says, both involved an HIV positive man and uninfected woman who desperately wanted to conceive a child but worried about its potential health status. One couple Boerner profiled and called Ted and Poppy; Ted had become HIV positive from earlier drug use. In the situation of the second couple, Susan and Dan Hartmann, the HIV was contracted by a tainted blood sample given to Dan to treat his hemophilia in the 80's when he was 12 years old.
“Part of the stigma of HIV is, ‘you must have done something really bad to get it,’” said Boerner. “But there are a variety of ways people get HIV.”
Boerner first encountered the concept of serodiscordant couples safely conceiving children when she was writing a story in 2011 for a hemophilia publication in San Fransciso.
“It just blew my mind,” she recalled. “What I thought was, ‘everybody has to know about this.’”
Growing up in the 80's, Boerner remembers the fear of HIV as a regular part of society. Hearing the stories of these couples made her want to spread the message to others in similar situations. For three years she spoke with doctors, patients and researchers in California before publishing “Postively Negative.”
Beofre stories like the Hartmann’s and Ted and Poppy’s, Boerner says options were limited for mixed status couples who wanted to conceive. Dr. Katherine Bunge, OB/GYN specializing in infectious diseases at Magee-Women’s Hospital of UPMC echoed her sentiments, saying alternative choices to conventional intercourse were often expensive, invasive and rarely successful. In Vitro Fertilization (IVF), sperm washing and IVF Intra-cytoplasmic sperm injection were suggested for reproductive assistance prior. Even after states lifted bans on sperm washing, which medically removes the HIV virus from semen, there are very few clinics offering the service.
Recently, HIV specialists have commended new research on Pre-Exposure Prophylaxis (PrEP), a method in which an uninfected person takes anti-retroviral medications in order to protect themselves from their infected partner. These studies, says Bunge, have not only been proven to prevent the spread of the virus for couples in general, but are especially useful for couples wishing to conceive. Truvada is the agent studied most extensively and has been estimated to be beneficial for about 460,000 straight women and even more gay men. When it comes down to it, though, Bunge says risk is always the biggest factor.
“The level of risk that someone’s willing to take is completely individualized to that couple’s experience with the HIV virus to their own relationship to everything going on in their life,” she explains.
For couples looking to conceive, like those chronicled by Heather Boerner, that risk is something that isn’t always supported by medical professionals. Boerner believes couples are willing to try more uncertain methods because the HIV-negative person already acknowledges they’re in an unpredictable situation: every time they have sex with their partner, they run the risk of becoming infected.
Dr. Bunge says the best way to approach the issue of conception is to have an “upfront discussion about fertility and tensions” and encourages pre-conception counseling.
Boerner says she hopes the stories of the Hartmann's and Ted and Poppy will encourage others to seek out resources for their own families. She’ll be speaking on Tuesday, Jan. 12 at 6 p.m. at Point Park University.
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