The Medical Challenges of HIV

Earlier this week I had the huge privilege of meeting Perry and Heather Evans and their two children, Isaac and Cerian at their home, eighteen years after I’d helped them to conceive their first child. It was one of those special moments in my career – and one that I will never forget as it has been such an honour to have been part of their remarkable journey.

Not only has Perry defied all the medical odds stacked against him throughout his illnesses, he and his wife Heather have also been able to enjoy a very happy and fulfilling family life.

From sperm washing…

It all started 18 years ago, when Perry and Heather came to me for help. At the time, I had just established the sperm washing programme for HIV positive men at Chelsea and Westminster Hospital in London. At the time, we were challenging the attitudes of many people who believed that men and women diagnosed with HIV should not even consider having children, let alone ask for help to conceive safely. A diagnosis of HIV not only carried huge stigma but was greeted with judgmental opinions from the vast majority of people, including the medical profession, who were ill informed and felt it was not appropriate or ethical to help those with HIV to have children.

In the early days, HIV had been viewed as a terminal illness but by 1999 it had been redefined as a chronic (long term) disease as a result of very effective treatments (antiretroviral medication called HAART). Men and women living with HIV now had a good life expectancy, similar to those living with diabetes, so there was no longer any justification to deny them the opportunity of having a family if it could be done safely. The real issue was preventing transmission of sperm from the HIV positive man to his uninfected partner. This is where sperm washing came into play. By preparing the sperm from the HIV positive man in such a way as to make it free of the HIV virus, it could be used to treat the female partner using intrauterine insemination or IVF techniques without any risk of infecting either the woman or the child. As a result of sperm washing, Perry and Heather’s dreams were fulfilled, along with thousands of other couples worldwide, over the following 15 years.

…to natural conception

In the past ten years, a further twist in the whole HIV story has taken place – something no one would have predicted back in 1999. In 2008 a scientific publication from Switzerland proposed that men and women living with HIV should no longer be regarded as infectious if they had been on HAART for at least six months and the virus could no longer be measured in their blood. Natural conception was now a real possibility. While this was challenged by many eminent scientists at the time, scientific research over the subsequent eight years has shown conclusively that this statement is true.

In July 2016 the ‘U = U’ campaign was launched. This is a simple but hugely important campaign based on solid scientific evidence.  U = U stands for Undetectable virus in the blood (through HAART) which means it is Untransmittable (so cannot be passed on sexually to others). This has been endorsed by the over 500 scientific bodies worldwide including the Centers for Disease Control in the USA and the British HIV Association. The campaign has already been successful in influencing public opinion and reducing the stigma associated with HIV.

Today, people living with HIV can live long, healthy and fulfilling lives, conceiving children naturally if they are on HAART – and not having to worry about passing on the virus through sexual contact. And if they suffer from infertility, they can be treated in using IVF in the same way as someone who is HIV negative. So, as we tell Perry’s remarkable story on World Aids Day, we should also celebrate this most important message.