related to heart disease), for which the specific complexities of HIV/AIDS did not obtain.

There has been widespread support for specialized health training and facilities for the care of women with HIV/AIDS; Bronx Lebanon Hospital has such a clinic for women (Citizens Commission on AIDS for New York City and Northern New Jersey, 1991). Such clinics, as planned, would focus on the social, economic, political, and psychological situation of women, factors that are often at the center of dealing with the nonmedical cofactors that affect the transmission and management of HIV disease.

As rates of HIV infection among women have increased, a number of medical investigators have begun to question earlier findings about the effects of HIV infection on the outcome of pregnancies. Asymptomatic HIV-infected female intravenous drug users in a New York City methadone program were not found to have decreased pregnancy rates or increased risk of adverse pregnancy outcomes. Moreover, acceleration in HIV disease during pregnancy was not found to be common (Selwyn et al., 1989b).

Data suggest that HIV-positive women are giving birth at rates normal for their age. Knowledge of their own HIV infection does not necessarily deter women from bearing children. Medical investigators associated with Montefiore Medical Center in the Bronx found that knowledge of HIV antibody status was not the overriding factor in decisions to terminate pregnancies; matters related to pregnancy—such as experience with a prior elective abortion, a negative emotional reaction to pregnancy, and whether the pregnancy had been unplanned—were more important (Selwyn et al., 1989a). Research conducted by anthropologist Anitra Pivnick among the same community of women explored the notion of reproductive choice in a broader context of family and social relations, economic circumstances, and cultural influences (see Pivnick et al., 1991). The 120 women in the study population—62 percent Hispanic (predominantly Puerto Rican), 30 percent African American, and 8 percent white—had a mean age of 34.9 years. Three factors distinguished HIV-positive women who chose to bear children from those who chose to terminate their pregnancy: prior abortion experience, the duration of knowledge of serostatus, and history of the mother's residence with existing children. Women who elected to continue with their pregnancies had a significantly lower lifetime abortion rate than women who chose abortions. They had also known of their serostatus for a significantly longer period of time, which presumably enabled them to consider decisions about childbearing without the pressures of pregnancy. Finally, women who had not lived with any child for 100 percent of the child's life were more likely to choose to bear a child than women who had that experience. (Many women in the study had themselves been "given away" by their own mothers and had confessed to life-long feelings of sadness and reproach.) Women who had managed to keep at least one of their own



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