by Jan Kriebs, CNM, MSN, FACNM, Assistant Professor and Director of Midwifery, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine
Today is World AIDS Day – a reminder that HIV and AIDS are part of life for 33.3 million people around the world. Women are 15.9 million of those infected.
I have worked with woman who are pregnant and HIV-positive for almost two decades. You cannot tell who they are by looking at our waiting room. Some are poor, inner-city women without jobs. Some are women with homes and careers. Some come alone to their visits, afraid of anyone finding out they have HIV. Some come with their husbands, sisters, or best friends. Since we have had access to highly active antiretroviral medications, none of the women who knew they were positive for HIV in early pregnancy and who took medication throughout their pregnancies, have transmitted HIV to their child at birth.
Our pediatricians report that the young children they see in the pediatric HIV clinic have mothers who were not diagnosed, did not seek care, or were unable to manage their medications.
In the United States, where recommendations for universal HIV testing have been in place for years and where a full range of medications are widely available, babies are still born who will carry the virus for their entire lives. Part of the problem is a woman’s fear. What will I do if I am positive? Who will want to be with me? Part of the problem is our collective unwillingness to believe that ANY woman might be infected as well as our failure to decrease the barriers to testing.
The most common cause of HIV in women is sexual activity; it is responsible for more than 80% of new infections. As midwives we must recognize that pregnant women are an at-risk population. It is easy to think that “our” patients are safe, but it isn’t true. We may also think that women who are privately insured, who live in safe communities, and who are married cannot be at risk. But risk is a tricky topic. These women may not be at high risk, but that is not the same as no risk.
The theme chosen for World AIDS Day this year is Universal Access and Human Rights. For the families, women, and children seen by midwives, access begins with testing. If you do not know your status, you cannot seek care.