Cuba: Pregnancy and HIV

Never did I think that I could be an HIV carrier. You never think about such things - as if you were immune from everything bad. When I listened to talk about AIDS, I felt I was tough and free from the plague, until one day they came to bring me the news. My world fell apart and there was darkness everywhere. Furthermore, my family was suffering with me. We did not have great living conditions. Thus, I entered the Sanatorium and gave up everything. Time went by and resignedly I became friendly with a young man and we fell in love. After one year of our relationship, I became pregnant.

Many people were afraid and told me not to have the baby. The doctors at the Sanatorium explained the risks to both the baby and myself, and that there was a 15 per cent chance of the baby being born infected. But I had made up my mind. For me, becoming a mother was the best experience a woman could have.

It was a period of many uncertainties and most people felt that the baby was going to die or would be born HIV positive. What would happen afterwards? I knew that some mothers had had regrets but I was determined to go ahead with the treatment.

Jonathan was born, amidst tears of joy and the uncertainty from the fear of knowing if he would be positive, in spite of the precautions and treatment. When he came into the world he had one of his tiny hands in his mouth, a sign that he was hungry, but I could not nurse him.

Living is a strange feeling. Walking, laughing, thinking in the darkness of the future. Sleeping without knowing if you will be alive tomorrow. Feeling the morning light, opening my eyes, seeing to my son and trying to be happy.

One of the most controversial and (contradictorily) least treated topics surrounding AIDS is the decision by an HIV positive woman to have a child. The fact that a woman is infected does not affect her biological capacity to continue the pregnancy; but the higher the mother’s viral load, the greater the possibility of her baby becoming infected. However, there is no viral load low enough to be sure. Infection may occur anyway.

Thus, even though the prevention of HIV in woman has special relevance for the number passing on the virus to their children during pregnancy, childbirth or breastfeeding, viral transmission is most likely to occur in the early stage of infection and in the advanced stage. The viral load present in fluids and in the birth canal, as well as the presence of sexually transmitted infections in the mother, increases the possibility of infection.

Fifty per cent of infected women have HIV in the vagina and the cervix. As a result, the risk of transmission increases if the membranes have been ruptured for more than four hours during childbirth, together with the time in which the foetus is exposed to maternal fluids. Because of this, pregnant women with AIDS are advised to deliver by elective Cesarean sections (C-sections).

Delivery facilitates the passage of HIV to the child’s bloodstream, in cases where the newborn is premature, thus involving immunologic, digestive and cutaneous immaturity. Breastfeeding is also responsible for increasing the risk of transmission by an average of 30 per cent, due to the presence of cracked nipples or breast abscesses in the mother.

According to global statistics, an average of 7,000 children are born to seropositive mothers each year, 26 per cent of who are born infected with the virus. Only 8 cases of mother to child transmission have been reported in Cuba to date.

There is a view that HIV positive women should not have children. Nevertheless, the right to decide to continue the pregnancy, to have or not to have children or an abortion is the individual choice of each woman. However, what is crucial is that the decision on the future of the pregnancy be made with a great deal of responsibility, accessing all available information, and with the partner’s consent as well. It is important to evaluate the individual wishes together with the consequences which the decision may have for the offspring, whether born infected or not.

In these cases, specialists offer pregnant women specific reproductive advice and other options that range from abortion to AZT therapy (antiviral therapy), informing them of its benefits, limitations and side effects. Mothers can reduce the risk of infecting their babies from 25 to 8 per cent using AZT, if the antiviral therapy is taken during the last six months of the pregnancy.

AZT (or Retrovir) reduces the activity of the virus but does not eliminate it. Its use to reduce the possibility of the perinatal transmission is recommended in controlled doses and under strict medical supervision. If the mother uses AZT and delivers by C-section, the risk of transmission can be reduced by approximately 2 per cent. If seropositive mothers do not breastfeed their babies, the probability of infection is further reduced by 14 per cent.

The majority of babies born to infected mothers test positive for HIV but a positive test result does not mean that they are seropositive, because newborns receive antibodies from their mothers even though they are not infected by the virus. If the babies become infected with HIV, their own immune systems will begin to produce antibodies and they will continue to test positive. If they are not infected, the mother’s antibodies will gradually disappear and they will test negative after 6 to 12 months.

Approximately 7 out of 10 babies eliminate the antibodies in the first six months. Only eight HIV treatments have been approved for children worldwide. An insufficient dosage can cause an increase in the viral load, which in turn, leads to consequences such as malnutrition, weight loss and growth problems which affect many HIV positive minors.

Since the beginning of the AIDS epidemic, it is estimated that 3.8 million boys and girls throughout the world have died before the age of 15, almost half a million alone in 1999. Another 1.3 million are living with HIV, the majority of whom will die before they are ten years old.

The authors are third year Social Communication students