Reducing the Odds Preventing Perinatal Transmission of HIV in the United States (1999) / Chapter Skim
Currently Skimming:
E New York/New Jersey Site Visit Summary
E New York/New Jersey Site Visit Summary
Pages 236-251
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From page 236... ...
* New York State requires its state-regulated facilities, such as hospitals, clinics, and HMOs, but not its private practices, to counsel pregnant women about HIV and perinatal transmission.
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From page 237... ...
At one program, for example, two of the four HIV counselors were hired with research funds. In light of the pivotal role played by counselors and other staff, program administrators were continually concerned that cutbacks in research or program funds would force them to scale back on their staff.
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For low-income pregnant women, Medicaid was the premier program that paid for medications and medical care. Medicaid financed laboratory tests, antiretroviral therapy and other medications, primary care, and hospitalizations, including labor and delivery.
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From page 239... ...
For instance, at New York's Bellevue Hospital Center, where prenatal HIV counseling is mandatory under the state's health regulations, about 20% of pregnant women refuse HIV testing.
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It is seen as an even more crucial gap in the labor and delivery setting, which offers the last opportunity to interrupt HIV transmission via administration of intrapartum antiretroviral therapy and advice to avoid breast-feeding. Bellevue Hospital Center has applied for permission to launch a voluntary, rapid testing demonstration program for all women in labor and delivery who previously have not been tested for HIV.
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From page 241... ...
Patients sometimes resorted to removing prescription labels. One patient, a former injection drug user, admitted to the IOM visitors her fears that the medication was addictive and actually caused AIDS, although she realized in retrospect that her fears were unjustified (see patient profiles)
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The singling out of at-risk patients was what offended patients, according to this view. Other reasons offered for private physicians' disinclination to counsel pregnant patients and encourage HIV testing were lack of financial incentives for counseling; lack of physician knowledge about complex HIV therapies and side effects; lack of referral networks; discomfort with counseling in general; and ignorance of the details of their state's counseling, testing, or consent laws and regulations.
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From page 243... ...
Among the barriers to HIV testing of pregnant adolescents are physicians' discomfort with discussing sexuality; physicians' lack of awareness that consent to testing (in New York and many other states) can be given solely by the adolescent and need not require the parent; and adolescents' fears of being reported, despite assurances of confidentiality.
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From page 244... ...
Many providers and programs offer free care or care at reduced cost, but federal law explicitly prohibits undocumented immigrants and certain categories of legal immigrants from receiving Medicaid. Instead of seeking pre
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Therefore, testing for HIV is viewed as completely unnecessary. Yet the women who ultimately agree to HIV testing and treatment do so out of motivation to help their child not themselves according to program administrators.
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She takes a cynical view of IDUs and sees drug abuse treatment as a necessary prerequisite for HIV testing and treatment of IDUs. When she was under the influence of drugs, she claims to
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Her second child also received an aggressive regimen of antiretroviral therapy. The HIV status of the second child, who was only three weeks old at the time Janet spoke to the committee, is not yet known.
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From page 248... ...
She said, "I was never counseled about HIV, never offered an HIV test, never told about the risk of HIV transmission, and never told my baby would be tested." After absorbing the news, she rushed to put her daughter on antiretroviral therapy. Her baby's health, not her own, was foremost on her mind.
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From page 249... ...
· Ensure availability of culturally and linguistically appropriate information and materials for immigrant women. Labor and Delivery · Make an accurate rapid test available for at-risk women whose HIV status is unknown.
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Newark, NJ 07103 Mary Boland, MSN, RN, FAAN, Director, Francois Xavier Bagnoud Center James Oleske, M.D., MPH, Director, Division of Pulmonary, Allergy, Immunology and Infectious Diseases Theodore Barrett, M.D., Director, University OB/GYN Associates Joseph Apuzzio, M.D., Director of Maternal-Fetal Medicine Tzong-Jer Wei, M.D., Acting Director, Division of Neonatology Paul Palumbo, M.D., Principal Investigator, CDC HIV Perinatal Cohort Study Deborah Storm, Ph.D., RN, Research Program Manager, Pediatric-Perinatal HIV Studies Judy Barros, MSN, CPNP FXB Center Ruth Fleshman, MSW, LCSW, Director of Social Work Services Lower New York Consortium for HIV-Affected Families Bellevue Hospital Center First Avenue and 27th Street New York, NY 10016 Keith Krasinski, M.D., Director
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From page 251... ...
and Broadway on 168th New York, NY 10032 Dr. Mahrukh Bamji, M.D., Metropolitan Hospital Cyra Borsy, Columbia School of Public Health Chris Cynn, HIV Law Project Danielle Greene, M.P.H., Columbia School of Public Health Cheryl Healton, Dr.P.H., Columbia School of Public Health Lynn Jackson, Metropolitan Hospital Mary Ellen Kelly, M.P.H., Metropolitan Hospital Stephanie Taylor, M.P.H..
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