now called zidovudine (ZDV)] if offered. Occasionally, a mother will tell me, "I'm glad I didn't know, because I might have had an abortion and even though my child has AIDS, I'm glad he/she was born."
Reasons Why Women Might Not Test
Why would any women choose not to test? If we want to save lives, we need to understand the reasons women might not test, and seek ways to address these concerns.
- Some think they are not at risk. ("I've only ever been with my husband.") We need them to understand that by virtue of being pregnant, they have engaged in a high-risk behavior with someone whose history cannot be known with certainty.
- Some fear that the anxiety of waiting for results (or of testing positive) will drive them to use drugs or alcohol. I have met many women who gave up drugs or alcohol when they found out they were pregnant, but whose ability to abstain was not very stable. If such a woman begins to use drugs but also takes AZT, how will this affect the fetus? If the woman begins to use drugs and avoids prenatal care altogether, how will this affect the fetus?
- Some fear violence, rejection or abandonment by a partner or family members if their HIV status is discovered (which it likely would be if she started taking AZT five times a day). One woman in our community did in fact die when she fell from a fourth story window while trying to escape an abusive partner. Another told us, "My husband hasn't touched me at all or shared dishes with me in the two years since my baby and I were diagnosed." Another became destitute (her baby was born into poverty) when her partner abandoned her.
- Some fear that their babies will be taken away by the authorities because of their HIV status. Whether this fear is perceived or real, it needs to be addressed. One woman I know went through six pregnancies that all ended in miscarriage. She did not seek prenatal care for the first five, afraid that being homeless and HIV-positive would result in her child being taken away at birth.
- Some fear that they will be forced to take AZT against their will. While most women are grateful that a drug exists that can reduce transmission, there is also a lot of fear and mistrust of AZT in many communities that can't be dismissed. There have been rumors of a woman who was required to take AZT during pregnancy as a condition of her parole, and of others reported to Child Protective Services for refusing AZT.
Testing Does Not Equal Care
Identifying positive women during pregnancy will save lives only to the degree that identification leads to care for both mother and baby. Unfortunately, I know of many examples of gaps in connecting testing to care.