Donor insemination and human immunodeficiency virus transmission

Objective: To describe cases of AIDS attributed to donor insemination identified through national human immunodeficiency virus (HIV)/AIDS surveillance and to compare the number identified through surveillance with our estimate of the number of women infected as a result of donor insemination before the initiation of donor screening. Methods: We reviewed national HIV/AIDS surveillance data on women reported through December 1996 and described characteristics of documented and possible cases attributed to donor insemination. We estimated the number of women infected before the initiation of widespread screening of donors using assumptions about the number of women inseminated each year, the average number of inseminations, the proportion of donors who were men who had sex with men, the prevalence of HIV among such men, and the rate of transmission per HIV-infected exposure. Results: A total of six documented and two possible cases of donor insemination-associated AIDS have been reported to the Centers for Disease Control and Prevention as of December 1996. An estimated eight to 141 women were infected through donor insemination in the United States between 1980 and 1984. Reasons for this discrepancy are discussed. Conclusion: Based on surveillance case reports and on our estimate, the total number of women infected as a result of donor insemination before screening was recommended is low. Current sperm bank practices to prevent HIV infection will be strengthened further by a pending proposal from the Food and Drug Administration requiring infectious disease screening and testing of semen donors. The most likely source of risk of new infections associated with donor insemination is self-insemination.