Now that HIV/AIDS is considered a long-term, manageable disease, advanced sperm-washing techniques have led to almost 4,000 cases of inter-uterine insemination without one case of HIV transmission. This possibility of parenthood is what often reaffirms the wellness of newly diagnosed patients. Bowers also discusses how addressing the AIDS crisis helped prepare the LGBT community for parenthood in general.
Medical Director for the HIV-Assisted Reproduction Technology (HART) Program, Dr. Dan Bowers has been on the forefront of HIV/AIDS treatment since the late 1980s. He has written, consulted and lectured for several AIDS service organizations, and serves on numerous not-for-profit boards.
HART is an acronym for HIV Assisted Reproductive Technologies. It was a program that was modeled after a lot of different attempts to use sperm from HIV positive men. And this was a coalescing of all the technology advances that have been made, not only in assisted reproductive technologies, but in HIV control.
Sperm washing was developed in 1990 in Italy. It’s been used throughout the world. It’s simple. You collect a semen sample, you spin it down, you collect the sperm at the bottom of the test tube, you throw away the white fluid, you put a cleaning fluid on top of it, you warm it up. The sperm wriggle themselves up to the top. You skim them off, and they’re washed. To date, 3,900 cases of inter-uterine insemination with double washed sperm, without one case of HIV transmission. Since that time, of course, we have in vitro fertilization. There have probably been about 900 reported cases of eggs fertilized from sperm from HIV positive men, with embryo transfer, without one case of HIV transmission.
Once triple drug combinations in about 1995, 1996, along with a test called viral load, we could actually see what we were doing with HIV care. We could give three combinations, and we could see virus in the body, in the blood, get to lower and lower levels until it was finally undetectable. Now, HIV medications have improved, and improved, and improved, so much so that first of all, they’re much simpler to take, they’re extraordinarily well tolerated. And the latest data on life expectancy, that’s come from the CDC in Atlanta, it matches the Athena Cohort, which is the HIV population in the Netherlands—is that if you’re a standard aged 25-year-old young adult, and you pick up HIV at age 25, and assuming you have access to medical care, and you’re mentally competent enough to take your medications, you should live an additional 52 years. In other words, you have a life expectancy into the late 70s, which is only about six months shorter than a 25-year-old HIV negative adult.
Being able to tell a newly diagnosed HIV-positive young person, who’s crestfallen, doing a lot of brow beating of how I could make this, you know, mistake in my life is, you know—part of that is to say, “Listen, you’re still a whole person. HIV can be a long term, manageable disease for you. You can be a triathlete. You can have long-term career plans, you can become President of the United States. You can also have kids.” And sometimes that last statement is almost as reaffirming of their wellness and wholeness as any other statement I make—the idea that I can say, “And now, you know, you can still have kids.”
Parenthood for gay men is actually the next step of the maturing of the LGBT community—that we came together to deal with the AIDS crisis, then we started to have political clout, we started to get recognized in both the Republican and Democratic party; we were out on TV. We had members in Congress. We started to be completely out to our families and colleagues. So we participated in family life, and suddenly we saw our brothers and sisters having kids, and we started to think, “You know, we want to have the same thing, too.” So this is the natural step of the maturing of the LGBT community.