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Counseling Emphasis on Newborn and Maternal Health
Counselors reported finding pregnant women to be generally receptive to HIV testing, even more receptive than women who are not pregnant. In their experience, the most persuasive arguments for patient acceptance of testing and treatment emphasized health benefits, first to the newborn and then to the mother. One counselor said, "We tell them [the pregnant women] that it's right for their baby, and what's best for the baby is also best for you." The experience of the counselors was confirmed by the patients who were interviewed. Virtually all patients described their newborn's health, before their own, as their overarching reason for proceeding with testing and treatment (see patient profiles). They described their experience as mothers as the best time of their lives. A number of them chose to proceed with subsequent pregnancies despite being HIV-positive.
Financing of Health Care
Most programs reported state and federal programs to be indispensable to financing health care. For low-income pregnant women, Medicaid was the premier program that paid for medications and medical care. Medicaid financed laboratory tests, antiretroviral therapy and other medications, primary care, and hospitalizations, including labor and delivery. Medicaid is relatively easy for pregnant women to obtain, if they meet federal and state eligibility requirements. Most programs helped their patients to fill out applications. Low-income women who are awaiting Medicaid approval or who do not qualify for Medicaid are eligible for supplementary coverage through a program called ADAP (AIDS Drug Assistance Program) that receives funds under the federal Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. This program covers, free of charge, HIV-positive patients' medications, primary care, and home care.
Routine Incorporation of Counseling into Care
Programs regarded another ingredient of their success to be the incorporation of counseling, testing, and treatment procedures into routine clinical practice. Well-established clinic policies and management support were seen as key. Programs understood that counseling, while laborand time-intensive, was pivotal to patient acceptance of testing and treatment. Some programs also had policies for repeat testing to ensure that patients did not seroconvert later in pregnancy. One program reported testing patients every three to four months if the patient was seen early in the prenatal period.