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For two weeks starting next Monday, a unique group will occupy the waiting room at Mount Sinai Hospital's fertility clinic in Toronto. These people, like the couples who are welcome here year-round, dream of having children.

Yet, when the two weeks are up, equipment touched by their eggs and sperm will undergo special sterilization. And if treatments fail, they must wait four months to try again.

The clinic is one of only a handful in Canada open to couples in which at least one partner is living with HIV, the virus that causes AIDS. The demand is so high that when the hospital's reproductive biology unit moves into a new, 15,000-square-foot facility in the spring, it will include a permanent, quarantined laboratory for cases involving people with HIV or hepatitis B or C.

"We've had to turn people away," said Mary Lyne, manager of the hospital's reproductive biology unit and in vitro fertilization program. "The clinic has made an investment to provide this service to patients [year-round]."

As World AIDS Day is marked today, the move is being applauded by doctors and activists who say it reflects a new reality for Canadians living with HIV. Medical advances have transformed the virus from a virtual death sentence into a chronic, manageable condition. And as people living with the disease plan on longer, healthier lives, many are planning families.

"Back in the 1980s, there weren't a lot of options for these people - and that's completely not true any more," said Mark Yudin, an obstetrician and gynecologist who runs a program for pregnant women with HIV at St. Michael's Hospital. "Young people of childbearing age want to have children. I think that as a society we should be doing whatever we can to help them."

But barriers to services still exist in many parts of Canada.

Only a handful of clinics specialize in cases in which one or both partners have HIV, and most are in southern Ontario, including Mount Sinai in Toronto and clinics in London and Mississauga. Couples outside of those areas must absorb the cost of travel and missed work to access treatment.

"I was totally, totally aghast at the response of the public and private clinics," said one woman from Montreal who is HIV positive and seeking donor insemination in Quebec. She has called six clinics in the past two months, she said, but each said they would not treat someone with HIV.

"If you're HIV positive and a woman, they really don't touch you," said the woman, who did not want to be identified. "I was stunned."

Because her husband has fertility issues, the woman, who is in her late 30s, is seeking donor insemination.

Other couples in which one partner is HIV positive seek reproductive technologies for different reasons. In particular, they want to minimize the risk of passing the virus from one to the other.

When a woman is HIV positive and her partner is negative, transmission can be avoided by inseminating her with the partner's sperm.

When a man is HIV positive, a procedure known as sperm washing separates live sperm from the seminal fluid, which can then be used to inseminate a female. The procedure appears to be very effective. No birth of an HIV-positive infant to an uninfected mother has been reported, according to a major European study. And in a case where both partners are HIV positive, it's still recommended that they avoid unprotected intercourse, Dr. Yudin said, so that they don't contract a different strain of the virus.

Dr. Yudin and his colleagues in Toronto sent surveys to 28 fertility clinics across Canada. Of the 20 clinics that responded, more than half said they provided some access to reproductive technologies for HIV-positive individuals. But complex procedures were less available, especially outside Ontario.

Their findings, presented earlier this month at the annual meeting of the American Society for Reproductive Medicine, showed only 30 per cent offered sperm washing for HIV-positive men, and only 20 per cent offered in vitro fertilization for HIV-positive women.

"I think we're off to a good start, but I think there is a long way to go," said study co-author Mona Loutfy, head of the Women and HIV Research Program at Women's College Research Institute in Toronto.

To help determine why those barriers exist, she says, a future study will look at the attitudes of doctors and reproductive specialists toward providing fertility treatment for people with HIV. But part of the problem may be logistical, she said, because treating these patients requires separate equipment and counselling procedures, which some private clinics may not be willing to fund.

"We would refer them to an alternate clinic because we're not really equipped to handle that," said John Havelock, a doctor at the Pacific Centre for Reproductive Medicine in Burnaby, B.C. "It would require buying separate storage containers and doing separate things in the lab. We're not physically set up for that type of case."

Jason Hitkari, co-director of the Genesis Fertility Centre in Vancouver, says his clinic has never been presented with a patient who has HIV, but if it was, that person would probably be referred to a clinic in Ontario.

Dr. Hitkari said he sees no ethical reason for denying treatment, but "unless you get a few patients, it's not logistically feasible" because of the extra cost involved in treating these patients.

But the Montreal woman who is HIV positive and seeking fertility treatment says she shouldn't have to change provinces to access the treatment.

Her next step, she says, is to try to meet face-to-face with clinic directors in her area, and persuade them that the procedure is safe, and that patients like her should have access to their services.

"The practice in Quebec is antiquated," she said. "I guess, like anything, it will have to change. But I need this to happen sooner than later."