Deon was in jail when he tested positive for HIV.
He knew that his long-term girlfriend was HIV-positive, and they hadn't taken many precautions to keep him safe. So he wasn't surprised by the diagnosis, but the news was still crushing.
"I was devastated," said Deon, 32, a San Francisco resident who asked that his last name not be used. "I didn't know if I was going to live. I didn't know if my social life was basically over. I didn't know how I was ever going to have a family."
Nearly five years later, Deon has a new girlfriend. And this month, she will give birth to their first child - a girl who, like her mother, is not infected with HIV. Deon, whose infection is so well controlled that the virus is undetectable in his blood, will have his family.
"She's due Feb. 20," Deon said. "I can't wait."
Deon and his girlfriend, Caroline, 24, are both being treated at San Francisco General Hospital's Ward 86 HIV/AIDS clinic, through a new program thought to be the first of its kind in the country that caters to straight men who are HIV positive and want to have a family.
The program, called Positive Reproductive Outcomes for Men, is part of the Bay Area Perinatal AIDS Center, which has been helping HIV-positive women give birth to healthy babies for more than a decade. It offers reproductive counseling and care to heterosexual couples, and includes support groups for straight men who are HIV positive.
Having kids now safe
There is no cure for Deon's HIV infection, but for men and women like him, having children of their own is, finally, a safe option. And it's further evidence that with the remarkable discovery of drugs to control the virus, a normal, productive life is possible for most people.
"I can't tell you how much I love this," said Guy Vandenberg, a nurse in Ward 86. "I love to see the relief on the faces of our patients when they discover this is a topic they can talk about and that there are options for them to have a family.
"A lot of our patients, once they knew they were HIV positive, they just sort of self-censored. They told themselves to stop thinking about family. This is one major step to making life with HIV as close to normal and complete as possible."
About 500 straight men with HIV are treated at Ward 86, said Dr. Deborah Cohan, medical director of the perinatal center who also is part of the Women's HIV Program at UCSF. In San Francisco, the HIV/AIDS epidemic has primarily affected gay men, and Cohan said issues like reproduction and pregnancy that affect mostly straight men and women often are overlooked.
Because HIV is an incurable sexually transmitted infection, unprotected sex between "discordant" couples - when one person is infected and the other isn't - is highly discouraged. Condoms are, and likely always will be, the first line of protection.
But over the past decade, several developments in scientific understanding of HIV and how to prevent infections have resulted in two important results: the ability to prevent an HIV-positive mother from infecting a fetus, and a new technique for preventing the spread of infection from one partner to another.
Scientists now know that people who are HIV positive but are taking antiretroviral drugs and have their infection under control - specifically, those who have a low viral load, or undetectable levels of virus in their blood - are very unlikely to pass the virus on to a partner. Pregnant women who are HIV positive also will not pass the virus on to the fetus if they are on antiretroviral drugs.
In the last two years, scientists also have shown that uninfected people can protect themselves by taking antiretroviral drugs too.
Doctors have put all of that information together to determine that men and women who are HIV positive and want to start a family can safely have sex with the goal of becoming pregnant. There are strict guidelines - most important, the HIV-positive partner must be taking antiretroviral drugs and have a low viral load.
Couples are instructed to have unprotected sex only when the woman is ovulating, and to use condoms at all other times. In some cases, the uninfected partner might also take antiretroviral drugs to offer another layer of protection.
But the key is that it's possible to have a family, doctors say.
'A paradigm shift'
"It's a bit of a paradigm shift," said Dr. Brad Hare, medical director of Ward 86. "We know now that it's absolutely safe, in a controlled way, for people to have healthy sex lives that protect their partners and can result in a family."
Starting a family was not an option for most HIV-infected people in the '80s and '90s. The risk of passing the virus on to an uninfected partner - or the child - was too great. Even if a healthy baby was born, most people with HIV died from AIDS within a few years of becoming infected, so they would never be able to raise their children.
The first break in family planning for HIV-infected individuals was the lifting of an adoption ban in the mid-1990s. Around the same time, scientists figured out how to prevent the spread of HIV from infected mothers to fetuses.
In the 2000s, some couples used sperm-washing techniques to get pregnant. The process involves collecting a man's ejaculate and then separating the sperm from the seminal fluid, which contains the virus. The sperm is then injected directly into the woman's uterus. But sperm-washing is expensive and not practical for many couples.
It's been only in the past two or three years that some doctors have been willing to discuss reproduction and family planning with couples affected by HIV. And still, many doctors aren't comfortable with it, Cohan said.
"People often have really strong, emotional reactions when they hear about an HIV-infected couple wanting to conceive," she said. "That's very scary for providers. We don't want to feel like we're somehow enabling an HIV infection. But we have a beautiful opportunity here."
Researchers at UCSF are conducting a survey of HIV-negative women with HIV-positive male partners about their thoughts on reproduction and family planning. Participants must be between ages 18 and 49. To take the survey, go to http://svy.mk/XkUwNw.
Erin Allday is a San Francisco Chronicle staff writer. E-mail: email@example.com