Unconventional conceptions and HIV

Abstract

The condom is widely recommended as the principal method for preventing HIV transmission, but such advice obviously does not apply to women who are seeking to become pregnant. In this sense, 'safer sex' is incompatible with reproduction. Existing research into HIV transmission has examined the choices made by those wishing to conceive within a sexual relationship; such research shows that HIV is not a highly significant factor in their decision-making processes. This study aims to extend the debate by exploring the decision-making processes of women seeking to become pregnant with donated sperm. In particular, we focus on women outside the fertility clinic system who do not have access to sperm screened for HIV to see whether HIV is a significant factor in these women's decisions. The study involved in-depth interviews with 20 women (14 lesbians, one bisexual and five heterosexuals) recruited through informal networking and snowball sampling. HIV was a salient concern for our sample, largely because of their contacts with gay men, but nonetheless most of these women took some risks. On the one hand, the conscious deliberations necessary to conceive through self-insemination facilitated risk reduction, as did factors such as 'stranger-danger'. On the other hand, factors such as the scarcity of suitable sperm donors and the women's own feelings of gratitude and loyalty to their donors mitigated against their requesting that their donor take an HIV test. This study highlights the need to provide information for women seeking self-insemination, and to remove restrictions on access to fertility clinics, in order to reduce their risk of HIV infection and subsequent vertical transmission.

Medically assisted reproduction in the presence of chronic viral diseases

“…This is a dif®cult choice because one cannot both provide assistance in reproduction and maintain a ®rm line of advice against pregnancy. However, lack of assistance in the desire for pregnancy leads a number of couples to choose to have unprotected sexual intercourse (Mandelbrot et al, 1997), an attitude involving risks in relation to the HIV virus which are known and have also been observed in other particular situations when women have been refused access to medically assisted reproduction (Macaulay et al, 1995;Matz et al, 1998;Block et al, 1999). These couples also tend to distance themselves from the medical structures by which they feel rejected (Nolan, 1990).…”