HIV Positive Women and the Challenges of Pregnancy
By Bolajoko Ogungbile
A publication of the Project Inform, a Non Governmental Organization (NGO) says: “If you've just been diagnosed with HIV and found out you're pregnant at the same time, you are probably feeling strong emotions that may include anxiety, concern or fear. Depending on whether your pregnancy is planned or unwanted, difficult emotions can overshadow other feelings of joy or excitement for a time. This is natural and you should give yourself time to deal with your emotions”.
No doubt, pregnancy period can be very challenging for women, and even to a caring spouse. It is even more challenging when the pregnant woman has other health problem(s) she is managing. The fact that she has to take care of the disease(s) and also take care of the pregnancy poses a greater challenge to the woman; she has to be 'treated with care and caution'.
Like a pregnant woman nursing other disease(s), HIV-positive pregnant woman also face peculiar challenges. These challenges depend on some other factors.
Dr. Bade Greg of Kings Foundation Hospital Limited, Lagos in an interview with the Daily Independent, spoke on what could happen when a woman does not know about her HIV positive status before getting pregnant. According to him, this can be categorized into different stages. There is the stage of shock when the news is broken to the woman, and this can pose a danger to the pregnant lady. If care is not taken, it may be followed by a stage of denial, whereby the woman may refuse to accept that she's actually positive. Eventually, most will accept their status though.
Dr. Greg emphasized the importance of counseling at this stage. According to him, since the woman was probably not expecting such news, if care is not taken, she may go into depression and even develop high blood pressure. And if this happens, it's going to complicate things the more.
He also stressed the need to let the HIV-positive woman know the truth about HIV/AIDS: that it can be managed just like diabetes and hypertension. "If an HIV-positive woman is pregnant or desires to be pregnant, it is not an impossible task, since diabetics and high blood pressure patients do get pregnant too."
Medical experts have warned that the following factors can increase the risk of a woman passing on HIV to her baby: being sick because of HIV/AIDS-related diseases; having a high viral load and a low CD4 cell count and a weak immune system; waters breaking for hours before the deliver; using hard drugs, particularly injected drugs and alcohol during pregnancy; having vaginal delivery (rather than a caesarian delivery) if HIV viral load is detectable; having a difficult delivery requiring, for example, the use of forceps; and breastfeeding.
By being aware of and avoiding these factors though, HIV-positive women can decrease the risk of transmitting the infection their baby down from 25 per cent to just two or three per cent.
In Africa, the issue of breastfeeding poses a major challenge because women are expected to breastfeed their babies. Medical experts have advised that an HIV-positive woman should not breastfeed her baby but rather use infant formula. The problem is that if she does not breastfeed, she is assumed to be HIV-positive, and vulnerable to stigmatization by family and friends.
In addition to avoiding breastfeeding, drug treatment is very important for every HIV-positive pregnant woman, for the sake of the child's health and that of the mother too.
People with HIV/AIDS are sometimes treated with the combinations of virus-fighting drugs called antiretroviral (ARV) that slow the spread of HIV in the body by keeping the blood levels of the virus low or even undetectable and help prevent AIDS-related infections.
The US Public Health Service recommends that an HIV-infected pregnant woman should receive treatment with these drugs as if she were not pregnant. It states that if a woman has HIV positive in her first trimester and has not been treated with any HIV-fighting drugs, she should be evaluated and treated. In the case of an infected pregnant woman who is already taking ARV treatment, it recommended that HIV-pregnant women be offered combination treatment with HIV-fighting drugs to help protect her health and to help prevent passing the infection to the baby.
When a pregnant HIV-infected woman receives good medical care early and takes antiviral medications regularly during her pregnancy, the chance that she will pass HIV to her unborn baby is dramatically reduced.
It is important that any woman who is pregnant and knows she is HIV-positive start prenatal care as soon as possible to take full advantage of such treatments. The sooner a mother receives treatment, the greater the likelihood that her baby will not get HIV.
In the past, before antiviral medicines were routinely given, almost 25% of children born to HIV-infected mothers developed the disease and died by 24 months of age. Recent studies have shown that mothers with HIV or AIDS who get good prenatal care and regularly take antiviral drugs during their pregnancy now have less than a 5% chance of passing HIV to their babies. If these babies do get the HIV virus, they tend to be born with a lower viral load (less HIV virus is present in their bodies) and have a better chance of long-term, disease-free survival.
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