Public Health Service (PHS) guidelines, birth certificates record whether or not an HIV test was done prenatally and during delivery. Additionally, the Texas State legislature passed a law in February 1996 requiring routine HIV testing with notification of all pregnant women at the first prenatal visit and during delivery, except for those who specifically opt out. Since 1995, the number of children diagnosed with AIDS has dropped.

A provider from the University Health Center who cares for diabetic and other complicated pregnancies reported that about 99% of these women are tested for HIV. In Centro del Barrio, a clinic that provides services to poor women in San Antonio and Bexar County, ten women (95%) are tested per month, and so far no one has tested positive. Family Health Services, part of the city's health department, delivers 4,000 of the 20,000 births in the county. They report that all pregnant women are offered the HIV test and 90% to 95% of these women accept testing. However birth certificates record that only 85% of pregnant women were tested. One of the physicians who provides care for HIV-infected women reported that 95% of women who are offered the test accept it. The other 5% refuse to be tested because of stigma, discrimination, fear of breach of confidentiality, and belief that they are not at risk.

Of the pregnant women tested and notified of their positive result, 5% refused zidovudine (ZDV) therapy during pregnancy and very few refused postnatal ZDV treatment for their babies. Most physicians use ZDV alone, although an increasing number use triple combination therapy.

When informed of the danger of breast-feeding to the baby, most HIV-positive women refrain from breast-feeding. The WIC program provides formulas to HIV-positive mothers.

Overall because of the AIDS Clinical Trials group protocol number 76 (ACTG 076), more HIV-infected women are having babies. They are aware of the ACTG 076 results and believe they can safely deliver the baby.

Programs Represented

Unlike Dallas and Houston, San Antonio has little local tax funding for HIV care so it relies heavily on Title I–IV funding. Because of the low prevalence of HIV in South Texas, there is strong competition for a small pot of federal money. One participant mentioned that there is no strong will to direct the money into prevention. However, despite this, there are connections that enable the present system to work. HIV-infected women in San Antonio are getting into care.

Many people who are HIV-infected are referred to the following sites: South Texas AIDS Center for Children and Families (STAIDS), Valley AIDS Council (VAC), Community First Health Plans, Centro del Barrio, and the San Antonio Metropolitan Health District. All except for Community First Health Plans (an HMO, health maintenance organization) receive federal funding from Health



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