care, women often engage in self-care, through home remedies, or seek the aid of unlicensed doctors who are paid in cash.
Those bold enough to seek prenatal care are commonly resistant to counseling and testing for HIV. Many Hispanic women are uncomfortable discussing sexual matters. Sometimes the subject is fraught with shame and guilt, especially for women who prostituted themselves to secure the funds to emigrate to the United States. For these women, discussion of sexuality is not only taboo, but it is also laden with fear about a husband or partner learning of their past. "It's even difficult to admit this to other women," observed a program administrator, who claimed that women who are not pregnant, yet seeking his organization's help, took an average of two and a half years to talk openly about their sexuality and the possibility of HIV testing. The program's policy is not to ask, but to wait for women to raise the subject on their own, a policy designed not to disenfranchise them. The consequences of disclosure of HIV test results to the husband or partner are dire: women are concerned about domestic violence, abandonment, and divorce. Divorce is feared because it may affect their immigration status and, consequently, their eligibility for Medicaid. Furthermore, HIV-infected individuals, by federal law, are excluded from entry into the United States (Immigration and Nationality Act, Section 212a).
Denial of HIV risk abounds. Women do not see themselves at risk, either because they do not engage in risky behavior or because they deny the possibility of their partners being at risk. From their perspective, "If a man is clean, then he can't be positive," according to a program administrator. Denial extends to the HIV status of their offspring. Under the assumption that children are God's creation, they can only be seen as perfectly healthy. Therefore, testing for HIV is viewed as completely unnecessary. Yet the women who ultimately agree to HIV testing and treatment do so out of motivation to help their child—not themselves—according to program administrators.
Paying for treatment is yet another deterrent to prevention efforts. Few of the women seen by the programs have private insurance or Medicaid. Being barred from Medicaid eligibility, the only avenue for undocumented women to pay for the exorbitant costs of care is through programs such as ADAP in New York (described earlier), designed for low-income, Medicaid-ineligible people infected with HIV. Newborns born to undocumented immigrants, however, are covered under Medicaid by virtue of being born in the United States, which confers U.S. citizenship.
In New York, unlike New Jersey, newborn testing for HIV is mandatory under State law. The New York testing program has been in effect since February