Often providers are so uncomfortable about answering these questions that their patients shut down, stop asking questions, and proceed with conceiving without the benefit of potentially harm-reducing measures.
I support "universal" testing, because too many medical providers dismiss the risk of their patients actually testing positive. This is evident in the very common practice of telling women, "Don't worry about it. We'll call you if there's a problem."
Well, I've spoken to the ones who were unexpected "problems." All too often they got a call from a shocked doctor's nurse at 5 p.m. on a Friday afternoon saying, "Your test is positive. You should see a specialist. I can't see you." Or a nurse calls to say, "The doctor wants to see you right away." Without saying anything more, the woman knows her diagnosis, and all too often it comes when she is at home caring for children, or at work surrounded by co-workers. Imagine trying to ''keep it together"—find a baby-sitter, drive a car, talk to your teenage children arriving home from school—under these circumstances.
We want pregnant HIV-positive women to stop using drugs, but how many programs allow them to keep custody of their children? How many are AIDS-sensitive? I have heard of many in which staff require residents known to be positive to use their own dishes and utensils. How appealing is that to a woman who is HIV-positive, addicted, and scared?
Most pregnant women are infected by men, yet there is very little social marketing that clearly tells men who have sex with women that condoms are their responsibility. Most prevention programs, posters, brochures, etc., tell women to "make" men use condoms. Let's be honest. Hasn't society kind of given up on men? If we hadn't, we'd tell them to wear condoms, instead of their partners.
For men to take steps to protect women, they need to value their lives and the lives of their partners. Yet there are few programs designed for men who self-identify as heterosexual to get support to come to terms with their diagnosis (and issues like drug use history or sexual orientation), and to take responsibility for protecting their health and others.
When I first tested positive, I thought women who got pregnant knowing they had HIV were selfish and irresponsible. It took a long time to admit that I was jealous that they had the courage to do the one thing I wanted to do. Now that I've done it, I get calls from women from all over the country and literally around