HIV-positive through New York State's mandatory newborn testing program. She was called back to the hospital one month after the delivery. The news was incomprehensible to her, for she had no reason to think she was infected, having gone regularly for prenatal care. She had even taken a breast-feeding class. She said, "I was never counseled about HIV, never offered an HIV test, never told about the risk of HIV transmission, and never told my baby would be tested." After absorbing the news, she rushed to put her daughter on antiretroviral therapy. Her baby's health, not her own, was foremost on her mind. It took her months to come forward and get treated herself. She reflected, "Women won't come in for themselves, only for their child." She is anguished to think she might have prevented infection by avoiding breast-feeding. "My biggest concern is that my daughter could have been infected with HIV unnecessarily," said Elina.

Patient 5: Maria

Maria is a Hispanic immigrant and former obstetrician in her home country who sees herself as having been victimized twice: once by her American husband, who infected her with HIV, and a second time by the legal system that bars her not only from U.S. residency (owing to her HIV status), but also from receiving her husband's benefits as a veteran. She nursed her husband for two years before he died of AIDS, only to learn that he had infected her. Upon applying for his veteran's benefits, she discovered that six months before her marriage he had married another woman, whom he also infected. The marriage licenses had been issued in the same building and same office. The first marriage invalidated her claim for widow's benefits, leaving her virtually penniless.

Because of her HIV status, she has faced discrimination in housing and employment. Her salvation has been New York's ADAP program which provides medications and medical care for HIV-positive people. As difficult as it has been in the United States, returning to her country would be far worse. Speaking through an interpreter, she said, "If I returned to my country it would be sure death." Her family has rejected her, and medications and services are unavailable to those in her country without the means to pay for them.

She has devoted herself to educating other Latina women to prevent them from spreading infection. Despite fears of deportation, she is determined to speak out about the plight of undocumented immigrants. "We need help for the sake of human rights," Maria lamented. "We live in limbo.… We have nothing to be able to survive."

Policy Options

The following policy options were recommended by programs that were visited by the IOM committee.



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