The Dilemma Faced by HIV-Positive Pregnant Women

by Dalia Acosta

HAVANA, Nov 28 (IPS) - Pregnant women living with HIV in Cuba are no longer under such heavy pressure to undergo an abortion, and perinatal transmission of the AIDS virus has been virtually eliminated through medical treatment administered to HIV-positive expectant mothers.

''It was really hard for me to come to grips with the fact that this was happening to me, and adapt to the new direction that my life had taken,'' a young women who preferred not to be named told IPS. ''After that, I built up a wall, and refused any possible relationship with a man.

''I was 17 years old when I was diagnosed as HIV-positive. Since then, 10 years have gone by, and many things have changed. Now I'm in a stable relationship, but what I did forget about was the dream of having a child,'' she added.

Giving up the idea of motherhood once and for all, opting for abortion in the case of accidental pregnancy, or assuming the risk of having a child are extremely difficult decisions faced by HIV- positive women.

Doctors in Cuba continue to recommend that women living with HIV interrupt their pregnancies, although the pressure has eased.

For many years abortion, which has been legal on demand in Cuba since 1965, was basically the only option left open to women living with HIV who found out that they were pregnant. Although a small fraction decided to go ahead and have their babies, most yielded to the heavy pressure applied by health authorities.

''Nearly all of them were persuaded not to give birth, and some were forced to have an abortion,'' said María Julia Fernández, who has been living with HIV for over 15 years, and who is active in AIDS prevention campaigns. ''But today they explain the risks, the possibilities, and you decide...it is your right.''

Until the early 1990s, people testing positive for HIV in Cuba were forcibly committed to a sanatorium, where they received medical treatment and special diets, while continuing to earn the salary they were paid at the time of their diagnosis.

But as scientific knowledge about HIV/AIDS grew and people living with HIV demanded more and more loudly to be allowed to live in society and continue on with their lives, the policy of Fidel Castro's socialist government was gradually modified.

Statistics indicate that up to mid-2001, 82 pregnant women living with HIV had decided to have their babies, and two of them even went on to have another child.

That represented 10.7 percent of HIV-positive women, and around half of the pregnancies were reported after 1997.

Of a total of 4,390 people diagnosed with HIV so far in this Caribbean island nation of 11.2 million, 1,034 have died, including 63 of causes unrelated to AIDS. Women have accounted for 21.1 percent of all cases of HIV/AIDS in Cuba.

Figures from the statistical department of the Santiago de Las Vegas Sanatorium for AIDS patients, located on the outskirts of Havana, show that 99 percent of HIV cases have been the result of infection through unprotected sex.

From 1986 to mid-2001, 84 babies were born to HIV-positive women. Of that total, 54 infants were diagnosed as free of infection at the time of their discharge from hospital, and 21 were still being monitored until their preliminary HIV-negative diagnosis was confirmed.

The special treatment plan, involving the administration of antiretroviral drugs to pregnant women and newborns, thus reduced mother-to-child transmission of the virus to nine cases out of 84, three of whom have died.

In addition, 13 of the children born to HIV-positive mothers have been left without a mother, 18 have lost their father, and five have lost both parents.

Health authorities attribute the small number of infants born with HIV to early epidemiological intervention and a permanent monitoring system.

''As part of their routine exams, all pregnant women undergo an AIDS test,'' explained Dr. Héctor Mengana, director of epidemiology at the Julio Trigo Hospital in Havana.

If the result is positive, it is confirmed with a second test, and the woman is provided with information and given the option of interrupting the pregnancy or going ahead with it under a strict treatment regimen.

That procedure is followed with women who are diagnosed with HIV during their pregnancies as well as those who consciously choose to have a baby even though they are already aware of their situation. Between 1986 and late 2001, 170,000 AIDS tests were administered to pregnant women.

The health care given to those who decide to give birth includes several measures aimed at preventing mother-to-child contagion, including treatment of the mother with the antiretroviral drug AZT starting in the 14th week of pregnancy, cesarean birth in the 39th week, and the elimination of breastfeeding.

International statistics show that by following these steps, the risk of perinatal transmission is reduced from over 30 percent to eight percent.

In Cuba, AZT has been administered to pregnant women since 1997, and between that time and mid-2001, no cases of direct perinatal transmission were reported.

During their first six weeks of life, babies born to mothers with HIV are given AZT in syrup form every six hours, in doses of two mgs/per kg of weight starting eight hours after birth.

But the final diagnosis cannot be confirmed until the baby is at least 18 months old -- the period needed for an uninfected child to eliminate the maternal antibodies to HIV and create their own.

''Those who are not infected are discharged, and the ones who are sick continue coming in for clinical visits every three months, although the mothers know that if they detect any symptoms, they are to take the child to the doctor immediately,'' said pediatrician Ida González, who is in charge of the treatment plan for all children born to mothers living with HIV.

Estimates by the accounting department of the Pedro Kouri Institute of Tropical Medicine indicate that the cost of treating an HIV-positive child up to the age of 18 months runs to 3,430 dollars.

That estimate was based on visits to the pediatrician from birth to 18 months, lab work-ups, the AZT administered to the mother up to the moment of birth by c-section, and the AZT administered to a baby weighing three kgs on average at birth.

According to United Nations statistics, 800,000 children a year are born with HIV worldwide -- a number that could be drastically reduced by providing the necessary medical treatment to HIV- positive pregnant women. (END/2002)