Deon, 32, is HIV positive and expecting a daughter. He’s being treated at a new San Francisco program that helps men with HIV safely realize their dreams of being dads. (Photo: Ryan Anson)

The public health message around unprotected sex for those with HIV has always been the same: Don’t do it. Even with huge strides in medical science that’s changed HIV from a death sentence to a chronic but manageable disease, that directive has not changed.

Now, a new program based in San Francisco is challenging this long-held campaign, and helping HIV-positive men have babies — the conventional way. The program run by San Francisco General Hospital, called PRO Men, teaches men about a range of reproductive options, from adoption to in vitro fertilization — where an egg is fertilized in a lab dish — to carefully timed intercourse.

“I would say as an HIV provider community, we have really failed these men,” says UCSF professor Deborah Cohan, who runs the hospital’s Bay Area Perinatal AIDS Center or BAPAC. “We really have not created programs to help them realize those goals and do so safely.”

With the discovery of drugs to treat the virus, Cohan said people with HIV are living long, healthy lives. And for those who want to start families, having “safe” sex, Cohan said, can mean foregoing condoms when a female partner is ovulating. Women can also take HIV drugs, which some studies show can protect against the virus. (BAPAC has helped HIV-positive women who adhere to their medications have healthy babies for years.)

“We know that if the person who is positive takes antiretrovirals and their viral load is suppressed, meaning the medication is working at killing all the HIV in the blood, that the likelihood of them passing HIV to a sexual partner is essentially zero,” Cohan said.

“Essentially zero” but not absolutely zero, Cohan says, because there’s some concern the virus can be in genital fluid even when it’s not detected in blood.

Despite this concern, couples are forging ahead with their family plans. Deon, 32, who thought his life was over when he tested HIV positive when he was in jail four years ago. Now he is about to welcome a baby girl with his fiancée Caroline. (Both Deon and Caroline preferred to go by their first names only.)

The couple became pregnant through unprotected sexual intercourse. Caroline does not have HIV, so the baby does not either. And she said she’s really not too concerned about getting HIV from her partner.

“He’s on his meds, and it’s a really, really, really low chance of me getting it,” she said. “And I just, like I love him, it’s not a big issue.”

BREAKING STIGMA

Though it may not be a big issue for Caroline, being HIV positive and having unprotected sex runs counter to just about every public health message that’s been put out for decades. Both state public health officials and officials with the Centers for Disease Control declined to comment for this story. The latest ethics report from the research and advocacy group American Society for Reproductive Medicine called the practice, “unsafe” and “not recommended.”

The San Francisco program is thought to be the first of its kind, and David Evans with the AIDS activist group Project Inform said it may stay that way for a while.

“I think stigma is still very, very strong in society about HIV in general.”

Evans, who has been following HIV medical science for decades and pushes for policy changes, said that in some states, doctors have refused to help those with HIV have kids altogether. Until about two years ago, health officials in Mississippi required people who tested positive for the virus to sign a form saying they would never have children. Evans said a program that affirms the right of people with HIV to have kids, and let go of condoms, could be revolutionary.

“I think this really changes things in a quite dramatic way,” Evan said. “And it is one of the last big remaining hurdles that I think many heterosexual men and women have to what they would consider living a normal, ordinary life.”

Case in point, as a typical father-to-be, Deon worries more about raising a daughter than he does about his HIV.

“It’s like ‘Oh my god,’” he said. “I definitely want her to know all kinds of self-defense. I envision her to be a black belt in karate.”

Caroline said she’s confident they’ll be good parents.

“We just have a really good relationship, like we really talk about everything,” she said. “He says I can make the decisions, but we make decisions together really, and things are just better when we’re together.”

The hospital treats about 500 straight men with HIV. The PRO Men program plans to launch a monthly support group in March that will also be open to men living outside San Francisco.

Listen to Mina Kim’s story:

By Alvin Tran

Condoms with a political message, handed out at the International AIDS Conference by St. James Infirmary, a San Francisco health clinic for sex workers. (Photo: Alvin Tran)

Police officers in San Francisco and Los Angeles may be undermining public health efforts to prevent the spread of HIV among sex workers.

That’s according to the findings of a new Human Rights Watch report “Sex Workers at Risk,” presented at the 19th International AIDS Conference in Washington, D.C. this week.

Researchers interviewed more than 300 people, including current and former sex workers in four major U.S. cities — San Francisco, L.A., Washington, DC and New York. They found that police officers were either confiscating or taking photographs of sex workers’ condoms as evidence of prostitution, putting sex workers at risk.

“Sex workers on the street are telling us that they are having unprotected sex with clients as a result of this practice,” said Megan McLemore, Senior Researcher at Human Rights Watch.

In L.A., New York and Washington, police confiscated the condoms and used them as evidence, but San Francisco police instead photographed the condoms before giving them back to sex workers. “They have some awareness that they shouldn’t actually be taking away the condoms permanently but we still consider that to be a confiscation because the condoms are seized,” McLemore said. “They’re targeted as evidence, and it still has the same chilling effect on people who don’t want to be harassed for condoms,” she added.

San Francisco’s anti-prostitution enforcement also differs from that of the other cities by targeting prostitution less on streets and more in businesses such as erotic dance clubs, massage parlors, and transgender nightclubs.

According to the report, the focus on businesses has interfered with the clubs’ willingness to have condoms available on their premises in a few cases.

“This undermines the efforts of the San Francisco Department of Public Health which has specifically targeted sex workers and transgendered women … for part of their condom distribution campaign,” McLemore told me.

The Centers for Disease Control and Prevention says the consistent use of condoms is highly effective in preventing the transmission of HIV and other sexually transmitted diseases.

But according to McLemore, many sex workers that her team interviewed were afraid to carry more than three condoms, meaning they might run out — putting them at risk of having unprotected sex with clients.

“Nowhere in the country is it illegal to carry above a certain number of condoms,” McLemore said. “That was the misinformation. That was another consequence of this.”

Tuesday afternoon, Officer Albie Esparza, public information officer for the San Francisco Police Department acknowledged the department’s policy to photograph condoms as evidence for prostitution charges.

Last week San Francisco Police Chief Greg Suhr sent a department-wide memo reminding officers “not to confiscate unopened condoms.” But the memo added that officers may photograph condoms to establish “probable cause for ‘Loitering for the Purpose of Prostitution.”

McLemore says Human Rights Watch plans to continue its research in other California cities including Oakland. “There have been some reports in Oakland,” McLemore said. “They weren’t consistent enough during the time that we were researching this report to include Oakland but that doesn’t mean that it is not happening in Oakland.”

Naomi Akers, Executive Director of San Francisco’s St. James Infirmary – a health care and social services agency for sex workers – is in Washington to attend the AIDS conference. Her goal is to raise international awareness about human rights for sex workers. Locally, she also said she hopes to meet with the SFPD to discuss policies around condoms.

McLemore is pushing for such a meeting to happen but says it must also bring together the District Attorney, Department of Public Health, and other members of the community to make sure that public officials follow through in taking action.

“The next step is to work with advocates in each of the cities to develop a specific advocacy plan and some goals and some targets and start meeting with public officials and pushing them to take action,” McLemore said.