New viruses demand new forms of awareness. HIV is hardly “new” to the world, or to India for that matter. But India has to wake up to a whole new range of medical practice, consciousness and ethics, prompted by the growing incidence of the virus in every stratum of Indian society. The newest hazard Indian medical practitioners will have to confront comes from the risk of women getting infected with HIV through artificial insemination. It is now known that a woman in Calcutta has tested positive for HIV at the School of Tropical Medicine, while her husband has tested negative. She has been trying to get pregnant through artificial insemination since 1997, and has received donor sperm three times so far, without managing to conceive. Her HIV-positive status was revealed when she got tested before adopting a child. Assuming that she has had no other sexual partners apart from her husband, has not used drugs intravenously, received blood or blood products, or worked in a healthcare setting, there is a very high possibility that at least one of her sperm donors was HIV-positive.
Before this case, there have been 14 women all over the world who are known to have been infected with HIV via artificial insemination from anonymous donors. But all of these cases occurred before the availability of HIV antibody testing. Since transmission can occur through fresh, frozen or processed sperm in both intrauterine and cervical insemination, donors will have to be tested very carefully by sperm banks in India, which work in a grey area between the illegal and the customary owing to the absence of proper legislation. Semen should be tested for HIV on the day of donation, and then the frozen sperm should not be used for insemination until it has been tested again after six months and found to be negative. International guidelines also recommend the use of frozen, rather than fresh, sperm, since the latter can be tested only once. Both HIV/AIDS and artificial insemination need a thorough medical, legal and political thinking-through in India. And the two could be related, not only because of the risks of transmission, but also because many women with HIV-positive partners could use their partner’s sperm, properly processed or “washed”, to inseminate themselves artificially and have a sero-negative child. These are still uncertain areas of medical practice, social behaviour, legislation and ethics. But, together with increased awareness in sperm donors, recipients and medical personnel involved in bringing them together, India will have to start thinking about these complicated issues with the rest of the world.