Florida prison officials make a special effort to ensure that all pregnant women are tested for HIV, and believe that almost all of them are tested. Testing is not, however, strictly required. Incarcerated women are given pre-test counseling in a group before their first physician visit.
Participants said that domestic violence is one of the most important barriers to testing. Many women do not disclose the results of their HIV test to their partners. They fear the results and lack the skills to negotiate sexual behavior, and there are no resources to guarantee women a safe environment. One participant said there needs to be consideration of whom to tell and how to tell them, and an escape plan for when partners become violent.
Participants feel that few HIV-positive mothers in Florida are injection drug users, although many of their partners are. Some use non-injection drugs such as crack.
Outside of the Miami and Tampa areas, perinatal HIV care is less intense than in other areas. In the Gainesville area, for instance, one small HIV center deals with cases from 13 counties. The doctors in this area rarely see HIV cases, and hence are not proficient at pre-test counseling. There are, however, two or three new HIV cases (in adults) per week, about one quarter of whom are seen by private physicians. Despite the presence of a state university medical center, the system has nothing to offer to these private patients.
There is an increasing number of repeat pregnancies in HIV-infected women in Florida, according to participants, and some of these are planned. Women see themselves as having more options since the ACTG 076 (AIDS Clinical Trials Group protocol number 76) results have been made public. In Orlando, there are few abortions among HIV-infected women, in large part because there are no resources to pay for them.
Representing the committee were Ezra Davidson, Jr., committee vice-chair, and Michael Stoto, study director.
Florida Department of Corrections
Office of Health Services
2601 Blair Stone Road
Tallahassee, FL 32399-2500
Sara A. Straub