the world. A small minority are in denial, but most are deeply concerned about protecting the health of their babies. One couple saved up money to fly from the Midwest to consult with BAPAC. In another case, my agency provided Greyhound tickets to a woman and her husband who traveled over 12 hours by bus so that she could deliver at BAPAC. This woman had a substance abuse problem, no money, no place to stay, and social workers who regarded her as an unfit mother, but she was willing to do whatever it took to protect her baby from being born infected.

Other Services Must Be Included in the Strategy to Reduce Perinatal Transmission

Substance abuse is one of the main factors in women avoiding prenatal care. To enhance the likelihood of HIV-positive pregnant women seeking care, we need HIV-sensitive treatment programs that will take pregnant women.

Breast-feeding is contraindicated in the United States for HIV-positive women. Yet when we go to WIC [Special Supplemental Nutrition Program for Women, Infants, and Children] to get formula (my formula bill for twins was $250 a month), we have to go through a nutrition class that pressures everyone to breast-feed without acknowledging that those with HIV shouldn't. My nutrition consultation was held in a room with an open door, and 10 other women sitting outside who could hear everything. I disclosed, but what would another woman do? WIC should include HIV education and awareness in their program. Also, WIC does not cover the full cost of formula. Perhaps in the case of poor HIV-positive women who do not have other ways of feeding their children, it should.

Prenatal care is critical in reducing the risk of transmission. But it's difficult for a woman with no car or child care to trek across town (or across the state) with her kids for medical appointments. Oakland did not allocate Ryan White funds to respite care until after I moved to another city where family could help with child care; and recently mothers who have since received that service have been informed that the hours available have been cut.

Doctors Should Be Supported to Provide Universal Testing

I've been a trainer at several state-sponsored trainings on the new pregnancy testing legislation. Doctors don't come. They send nurses and secretaries. They're too busy. They don't think their patients are at risk. They mostly want to know how to comply with the law without losing a lot of time.

Who can blame them? They've been mandated to offer testing, but don't have a mechanism to get paid for what it really takes to do good pre-test counseling and education. It makes no sense to me. It's like telling restaurants that sell BBQ ribs, "You have to serve a dinner salad first, because it's good for people's



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