. "I HIV Testing and Perinatal Transmission: Thoughts from an HIV-Positive Mother." Reducing the Odds: Preventing Perinatal Transmission of HIV in the United States. Washington, DC: The National Academies Press, 1999.
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For example, in the "East Bay," we have no obstetrician or perinatologist specialized in the care of HIV-positive pregnant women. This means that if a woman from Oakland, Richmond, Berkeley, or Fremont (all high-incidence cities) wants specialty care, she must travel; across the Bay Bridge to BAPAC [Bay Area Perinatal AIDS Center] at San Francisco General Hospital (an hour by public transportation).
"Sandra" delivered her baby in a high-incidence city to a doctor and medical team who knew she was HIV-positive. They—not just the doctor, but—the entire team forgot to administer intravenous AZT.
"Alicia" recently delivered a baby prematurely, in her seventh month of pregnancy. Her HIV status and pregnancy were known to medical providers, but she did not keep medical appointments. As of the date of delivery, she had never taken any antiretrovirals.
"Meg" tested positive at five months of pregnancy in a rural town. Her doctor handed her the results of her blood work and said, "You're HIV-positive. I can't treat you. Here are your lab results (T-cell counts, etc.) but I can't tell you what they mean."
When "Kim" asked her doctor if he knew how to manage an HIV pregnancy he said, "Oh, yes. Don't worry. We use gloves during the delivery with everyone." This same doctor, who knew she was HIV-positive, asked her three times, "Now, tell me again why you're not planning to breast-feed?''
"Natalie" had an undetectable viral load on a combination of two drugs when she found out she was pregnant. An obstetrician who had no experience with HIV told her to go off her drugs immediately because she was in her first trimester. Almost immediately her viral load went from undetectable to over 130,000 [copies/mL].
"Kelly" tested positive at age 22, during a planned pregnancy. Within an hour of her diagnosis she was told, "We can schedule the abortion today." It was only after she terminated her pregnancy that she learned that there would have been a good chance of the baby being born HIV-free.
"Sheila" knew she was HIV-positive when she became pregnant by accident. Her doctor put her on AZT and d4T (a combination that is contraindicated in any HIV-positive person, pregnant or not). When her baby was four weeks old, her doctor administered the RNA PCR [polymerase chain reaction] test (which gives a number value) for the baby instead of the DNA PCR test (Which shows "positive" or "negative"). The viral load count of 100 that was reported by the lab may be a false positive, or it may not. Because of her doctor's lack of experience and knowledge, she has either gone through an unnecessary scare, or lost valuable time in which she could have had the option of intervening with a combination of antiviral drugs.
"Andrea" asked me if she should go to BAPAC and pay out of pocket because she was concerned that her HMO [health maintenance organization] was