pregnancy, and then the women ends up returning to Texas without accessing HIV care.

Culture

The family unit is very important and highly regarded in the Hispanic culture. HIV infection, however, is seen as a threat to the cohesiveness of the family. One patient noted that the worst thing for a Hispanic family is having a member who is homosexual, uses drugs, or is promiscuous. In the Hispanic culture, HIV encompasses those aspects and so one who has HIV is considered "not good." Some positive women, then, are reluctant to tell their families of their HIV infection. Single women who are pregnant and have HIV must also deal with the additional stigma of being a single unwed mother.

Since "family" is so important in the Hispanic culture, many women do not use birth control. For instance, women feel that they cannot ask a man to put on a condom because as his wife or partner, she would not be satisfying him. Because of the importance of the family, on the other hand, a pregnant woman will work out of her culture and seek early prenatal care and take medications if she understands there is a benefit to her baby. Usually, the women are more compliant in using formula if they know that breast-feeding may harm the baby. All of the patients who were interviewed stressed the importance of taking the medication "because of the baby."

Patients

Patient 1: Theresa

Theresa (a pseudonym) is a Hispanic woman who was tested for HIV in 1994 and was negative. In 1998 she was tested again after signing forms for a test she thought was routine. She was 6.5 months pregnant at time of diagnosis, and she had never received information on how HIV transmission from mother to child can be prevented.

Upon receiving the positive test result from her provider, who is a medical resident, Theresa at first did not believe it. She asked questions about HIV, the medication, its side effects and potential harm to the baby, yet the resident was unable to answer the questions or refer her to specialized care in San Antonio.

Theresa felt "dirty, not worthy, trashy, and filthy." She perceived that HIV-positive people were prostitutes and drug users, and that people would see her in the same light. Luckily a nurse practitioner overheard the conversation between Theresa and the resident, consoled Theresa, and told her about Community Pediatrics. Unfortunately Theresa was still distraught and contemplated suicide on her way home. However the counselors at Community Pediatrics were very helpful



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