Asked to be a sperm donor: disclosure dilemmas of gay men living with HIV

Previous research has documented the various challenges people living with HIV face as they navigate intimate relationships, including what is often referred to as disclosure. In studies of gay, bisexual and other men who have sex with men, the issue of telling or not telling others about an HIV-positive status has been examined primarily in relation to communication with sexual partners, with few studies focusing on other aspects of intimacy. Drawing on interviews with gay men living with HIV, conducted in four clinics in London, this article explores the narratives of men who have been asked by female friends about the possibility of being a sperm donor. The narratives highlight layers of complexity which have received little attention, not only in research on HIV but also in studies of sperm donation and co-parenting. The article advances dialogue between these two largely separate bodies of work. Our data suggest that reluctance to share an HIV-positive status with others can be an important factor in deciding how to answer the 'sperm donor question'. Examining reproductive relationships of a specific kind - those based on friendships between women and gay men - the article develops the understanding of how secrecy about HIV shapes intimate lives.

Discussing parenthood with gay men diagnosed with HIV: a qualitative study of patient and healthcare practitioner perspectives

BACKGROUND

Research on HIV and reproduction has focused largely on women and heterosexual men. This article examines whether it is relevant to address parenthood in HIV care with gay men and what ways of doing so are most appropriate.

METHODS

Qualitative interviews were conducted at four London clinics with 25 men living with HIV, aged 20-45, who did not have children, and 16 HIV clinicians. A thematic analysis identified potential reasons why parenthood was rarely discussed with gay men in HIV care.

RESULTS

Two sets of ideas contributed to a lack of conversations about parenthood: clinicians' ideas about what matters to gay men and men's ideas about what it means to be HIV-positive. Both sets of ideas largely excluded having children, with patients and practitioners similarly unlikely to raise the topic of parenthood in the clinic. Contrary to what clinician commonly assumed, many men expressed interest in receiving more information, highlighting the importance of reassuring people upon diagnosis that it is possible to become parents while living with HIV.

CONCLUSIONS

Parenting desires and intentions were rarely discussed with men in HIV care. Our findings illuminate the potentially beneficial effects of emphasising that having children is a possibility at diagnosis, regardless of patients' gender or sexuality. Conveying this information seems meaningful, not only to men who want to become parents in the future but also to others, as it appears to alleviate fears about mortality and ill health.

Can HIV-positive gay men become parents? How men living with HIV and HIV clinicians talk about the possibility of having children

It is now established that people living with HIV who have an undetectable viral load and adhere to antiretroviral treatment cannot transmit HIV to their sexual partners. Previous research has shown that 'being undetectable' changes how HIV-positive gay men experience their sex lives. But how does it affect gay men's reproductive behaviours? And what influence does it have on views about parenthood at a time when gay fatherhood has become more socially accepted and publicly visible? Drawing on qualitative interviews with patients and clinicians at four HIV clinics in London, we identify differences in how interviewees talked about the possibility of having children for HIV-positive men. Both groups, unprompted, frequently referred to sperm washing as a method enabling safe conception. However, whereas clinicians talked about sperm washing as an historical technique, which is no longer necessary, patients spoke of it as a current tool. The men rarely mentioned being undetectable as relevant to parenthood and, when prompted, some said that they did not fully understand the mechanics of HIV transmission. Our findings offer new insights into how biomedical knowledge is incorporated into people's understandings of living with HIV, raising important questions about how the meanings of being undetectable are communicated.

Sexual identities and reproductive orientations: Coming out as wanting (or not wanting) to have children

In the context of growing visibility, recognition and acceptance of lesbian motherhood and gay fatherhood in countries such as Britain, it is important to ask how younger generations of sexual minorities approach the possibility of becoming a parent. Drawing on interviews with lesbians and gay men who do not have children but may have them in the future, I explore how people become aware that having children is an option. By attending to how this consciousness manifests in conversations and how conversations shape the consciousness, I illuminate specific dynamics that raising the topic of parenthood creates in intimate interactions. My data show that it is often unclear to men and women who form same-sex relationships whether they are socially expected to have children. I argue that this ambiguity requires a kind of 'coming out' through which feelings about parenthood are made explicit. Using the concept of coming out, I ask: What if we were to think of people in terms of their 'reproductive orientations' rather than sexual identities? I suggest that, similar to expressing sexual identities, articulating reproductive orientations involves aligning with particular life trajectories based on binary logic. However, with ambiguous expectations about parenthood, neither having children nor remaining childfree is explicitly normative. As such, unlike coming out as lesbian or gay, which transgresses norms surrounding sexuality, coming out as wanting or not wanting to have children challenges normativity itself. I reflect on how this 'normative challenge' makes it possible to imagine parenthood and 'childfreedom' as intimacies of equal value.

Parenthood as intended: Reproductive responsibility, moral judgements and having children 'by accident'

What does it mean to have a child 'by accident'? And why is parenthood so often described as happening 'accidentally', even when it is likely to involve at least some degree of intention? Drawing on interviews conducted in England and Wales with lesbians and gay men who do not have children but may have them in the future, this article explores the meanings of the notion that, as a same-sex couple, 'you can't have a child by accident' - a comment that interviewees frequently made unprompted when they were asked about the possibility of becoming parents. My data show that referring to 'accidental parenthood' is a common way of distinguishing one's experience of early adulthood from that of heterosexual people, especially among white, middle-class lesbians. As a closer reading of the data also suggests, parenthood that arguably happens by accident is often neither unforeseen nor unfortunate, and its currency as a point of reference reveals a powerful cultural narrative. When a wide range of reproductive behaviours are often deemed irresponsible because of their broadly defined timing, describing a pregnancy as an accident obscures responsibility. I argue that, to a certain extent, the discourse of accidental parenthood can serve to prevent moral judgements about reproductive decisions. Consequently, however, the 'inability' to have a child by accident makes the prospect of creating a family not only more complicated but also subject to greater scrutiny.

More Natural Does Not Equal More Normal: Lesbian, Gay, and Bisexual People's Views About Different Pathways to Parenthood

Heterosexual reproduction is often seen as normal and natural, with the two descriptors commonly understood as mutually reinforcing. I argue that, despite their apparent similarity, the meanings of "normal" and "natural" are distinct in important ways-a distinction that questions the positioning of lesbian motherhood and gay fatherhood as inferior. Through an analysis of lesbian, gay, and bisexual people's ethical judgments about different ways of creating families, I show that pathways to parenthood that make a family appear "more normal" rely on means of reproduction that seem, in fact, "less natural." Conversely, reproductive possibilities seen as "more organic" create families that depart more substantially from the cultural norm of the nuclear family. As a result of this tension, different pathways to parenthood can be justified as being "in children's best interests." However, while this children-centered justification can be flexibly applied, it also has contradictory meanings.

Repro-sexual intersections: sperm donation, HIV prevention and the public interest in semen

In the scientific literature on fertility and assisted reproduction, and in the corresponding area of clinical practice, increasing attention has been paid to two groups: people living with the human immunodeficiency virus (HIV) and gay men. However, research on fertility in the context of HIV focuses almost exclusively on heterosexual couples, whereas studies on non-heterosexual reproduction rarely mention HIV, despite the fact that, in many western countries, HIV prevalence among men who have sex with men is higher than ever before and men who have sex with men are the only group in which new HIV infections are on the rise. This review identifies links between reproduction, HIV and homosexuality, showing that, historically, they are closely intertwined, which has important implications for current issues facing HIV care and fertility services. Considering sex and parenthood as two different but related kinds of intimacy and kinship, the dual role semen plays in sexually transmitted infection and in assisted reproduction is discussed. The review reflects on the future of sperm donation and HIV prevention, asking whether two challenges that potentially face healthcare and medicine today - the shortage of 'high-quality' sperm and the 'surplus' of infected semen - could be addressed by a greater exchange of knowledge.