In 1984, I took care of my first pregnant patient who was infected with the human immunodeficiency virus (HIV). Having virtually no experience with HIV or AIDS, I called several of the leading AIDS experts in the country to ask how I should care for her.
The response I got was: “You mean a woman can get this disease?”
Subsequently, we learned that not only were women at risk of contracting HIV from sexual intercourse and IV drug abuse, but their babies could contract it in the womb or around the time of delivery. The original research on HIV and pregnancy stated that 1 in 4 or 5 babies would contract HIV from his or her mother.
Two major developments have dramatically reduced the transmission of HIV from mother to baby.
AZT and triple-drug therapy given before birth and in labor
Most recently, the research finding that having an elective Caesarean delivery further cuts the risk
Nowadays, for a woman who has been taking her medication through pregnancy and whose blood does not have any detectable virus in it, the risk of passing HIV on to her baby is almost zero.
After delivery, it is also recommended that women who are HIV positive do not breast-feed because of the possibility that HIV could be transmitted through the breast milk. (This advice is for women who live in developed countries where formula is readily available — it’s controversial in the developing world, where formula is expensive and clean water hard to find.)
I believe that every pregnant woman should be voluntarily tested for HIV during pregnancy because of the remote possibility that she may have the virus and the devastating consequences if it goes untreated. The American Academy of Obstetrics and Gynecology also endorses routine, prenatal testing for HIV.
All women who have sex with men are at some risk of getting HIV because their partners may have unwittingly contracted it in any number of ways: sex with a gay man, sex with a man whose prior partner was HIV positive but didn’t know it, sex with a prostitute or through IV drug abuse.
This is thought to be because of complacency leading to less stringent attention to condom use and other safe sex practices.If HIV numbers are up among gay men, statistics on other groups, including heterosexual women, are likely to follow.
Of all of Dr. C. Everett Koop’s accomplishments, one of the most important is his willingness to speak out about the growing AIDS epidemic and to have a frank discussion about the need for HIV testing and safe sex practices. It is one of the best ways for us to remove the stigmas associated with this now treatable disease.