Obtaining and analyzing test results can also be very difficult. In one system, the physicians themselves must call the lab directly to obtain test results. Some tests may not be returned because the physician forgets or the patient forgets to remind the doctor to obtain the results. At one site to counteract this problem, a nurse practitioner obtains all the lab results and reads through them to find an HIV-positive result. Once she finds a positive result, she determines which physician has seen the woman most often and then asks the doctor to contact the woman.

The analysis of the test results are sometimes misinterpreted. In a number of cases, women with a positive ELISA and indeterminate Western blot were incorrectly informed that they were HIV-positive. Although all were eventually retested, this lack of attention to important facts about HIV testing may result in the patients' mistrust of their care providers and may contribute undue stress in the women's lives. In one such situation, a woman told her husband of her positive status, and he left her immediately. When her initial results were found to be false positive, it was already too late.

Some doctors seem misinformed of the standard procedure for administering the ACTG 076 regimen or assume that pharmacies automatically have injection ZDV in stock. For example in Harlingen, one physician requested administration of ZDV during labor of an HIV-positive woman, not knowing that the Harlingen hospital did not automatically stock ZDV. Unfortunately by the time the medication arrived from San Antonio, the woman had already delivered the baby. The participants believed that this situation is seen in many other smaller towns where there is a low prevalence of HIV/AIDS. Some doctors do not know the proper administration of ZDV during labor. One doctor reportedly said, "We don't use injection form here."

The distance to travel for health care is also an issue. For example, one grandmother must travel 150 miles both ways so an infant can take part in a drug trial. One of the patients interviewed said that if she were to take public transportation to her clinic, it would take her two hours. Considering the importance of complying with the ZDV regimen, transportation can be considered a barrier when caring for HIV-positive pregnant women. Some providers around the LRGV must travel 1400 miles in less than a month to deliver the results to people. Transportation is "expensive, labor intensive, and time consuming."

Finally, there is difficulty in notifying the woman of a positive result. Many women are lost because they provide false addresses (often because of immigration concerns). Others are lost because of the effects of a provider's unsympathetic notification of the positive result.

Texas Law

In response to the lack of preparation in dealing with HIV and delivering medications, the Texas legislature passed a law in February 1996 that requires



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