How to give birth to a child if one of the partners is HIV-positive
BIRTH OF A CHILD AND MOTHERHOOD gradually ceases to be perceived as a mandatory item of the "women's program" and the most important marker of the viability of a woman. The social installation is replaced by a personal, informed choice - and now it is possible to have a child, thanks to the achievements of medicine, at almost any age and circumstances. Nevertheless, the fear of childlessness remains very strong, and a number of situations are surrounded by a cloud of prejudice and opinion based on medical illiteracy. One of the most striking examples is the relationship of discordant couples, where one of the partners (whether it is a woman or a man) is HIV-positive.
The lack of available information about prevention and sexual education has led to the fact that the HIV epidemic has been diagnosed in the country, and the diagnosis itself continues to be terrifying and sounds like a sentence to many people. Panic (as opposed to sound measures) is inappropriate: modern therapies enable HIV-positive people to live a full life - including having children.
We asked about the experience of pregnancy and the birth of a child in a discordant pair of two heroines who were lucky with the support and understanding of friends and relatives - but who met with discrimination where they didn’t wait. And Anna V. Samarina, MD, Head of the Maternity and Childhood Department of the St. Petersburg AIDS Center, Associate Professor of the Department of Socially Important Infections of the PSPbGMU named after M. Gagarin gave specific medical recommendations to discordant couples who decided to have a child. Acad. I.P.Pavlova.
Nataliya
HIV negative, husband is HIV positive
mother of five year old son
The fact that my future husband was infected, I learned almost immediately - on our first night, when it came to sex. We did not have condoms, and he said that we could not do without them, in any way, in general, because he is HIV-positive and is obliged to tell me about it. I took it somehow very easily: his frankness and honesty reassured me and arranged, even somehow attracted.
There was no fear. He told me his story in great detail: how he found out about everything by chance, while undergoing examinations, and along the chain it turned out that he had become infected from his girlfriend, and she, in turn, from his previous partner. They had a serious relationship, not some casual relationships, they were even going to marry, but the relationship faded away for some reason unrelated to the diagnosis. Anyway, after learning about everything, they immediately got registered. This is an official practice: if you, for example, go to the state hospital for an operation, you must be tested for HIV, and if it is positive, you are automatically registered in the infectious diseases hospital on Falcon Mountain, in the AIDS center.
Already there, my husband passed all studies on the immune status and viral load. If everything is in order, then HIV-positive people do not need to do anything, just lead a normal healthy lifestyle and be monitored, get tested regularly and check if the virus is progressing. If immunity begins to fall, prescribe therapy. All indicators of the husband were in the normal range, so that he lived and now lives a full life, in which almost nothing has changed since the diagnosis was made. It only taught us both to be attentive to our health and not to neglect routine examinations, to eat right, to go in for sports more, to look after ourselves. The only restriction that the diagnosis has brought into our lives is protected sex, always, no matter what state we are in. In a fit of passion, tired after the party, we never lost control, and there was always a supply of condoms in the apartment.
Naturally, after a while of living together, I was covered with a wave of experiences: what awaits us in the future, I rushed to google, I was scared for him, scared for myself and for the opportunity to have children. Actually, the most terrible thing was that this is a very taboo topic that you cannot calmly tell about. Therefore, I did not talk for a long time on these topics with my relatives, but with just acquaintances, in whose adequacy I was sure, it was easier. The reaction was most often normal, but I was lucky with the environment.
The fact that people are poorly informed is an understatement. So when we decided to have a child, we first went to the AIDS center, where I was told about the official statistics: that the probability of infection in the normal state of the body and a single sexual intercourse on the days of ovulation is minimal. I even remember a piece of paper that was glued on the table: the probability of your infection is 0.01%. Yes, she still has, yes, this is a little Russian roulette, especially if you can not get pregnant with one. You can tense up and do IVF to fully protect yourself, but this is the load on the body, coupled with hormone therapy, which can be avoided.
I very clearly planned pregnancy, prepared like any woman: completely eliminated alcohol, began to practice yoga, eat right, drank vitamins and trace elements. The husband, for his part, went through all the checks at the AIDS center, where he also didn’t reveal any contraindications.
I got pregnant immediately after the first attempt, and, having learned that I was pregnant, I immediately went and did an HIV test. It scared me only what responsibility I bear for my child and his future life - if I suddenly become infected and give him a virus. The analysis was negative.
I immediately decided to conduct a pregnancy in the paid department, and everything was fine until I had a terrible toxicosis. Then I told in a blue eye that my husband is HIV-infected. I remember how the doctor stopped writing and said that "we, of course, can recommend to lie with us, but it’s better not to." I visited them a couple of times and in the second trimester, when I had a paid contract, I was directly told: "We cannot take you." I, anticipating any questions, made an analysis in advance at the independent laboratory and brought it with me - it was negative, and they had no reason to refuse me. On my proposal to retake the analysis from them, if they doubt, they started fussing and said: “No, no, we don’t have to donate anything, go to your AIDS center and donate everything, and then, if everything is all right, you can return ". In the AIDS center we were very strongly supported, they said that this was an absolute violation of my rights, and they even offered the help of their legal service if we want to sue.
Everything worked out peacefully, although it took to raise the head physician to my ears, which was very harsh and even cruel with me - and by this time I was also in the third month of toxicosis. And here with me, a man in an exhausted state, they talked very dismissively, as if with some sort of garbage from society. I remember her words: "Well, have you gotten involved with such." Of course, I was hysterical, I cried, said that it was impossible to humiliate a person like that. In fact, if I hadn’t said anything about the status of my husband, they wouldn’t even ask. As a result, they apologized to me and behaved much more correctly - problems arose only before childbirth, when it turned out that an HIV-infected partner could not attend them. Moreover, it seems to me, after seeing our relationship with my husband, seeing what we, the doctors have realized something about. And this very well demonstrates the public attitude towards HIV-infected people: it seems to everyone that these are some kind of “not such people”, and in fact anyone can be the carrier of the virus. It won't even occur to you that a person can be HIV + if he looks “normal”.
During the entire pregnancy, I passed the analysis seven times, and everything was always in order: we had a completely healthy baby, and I told my mother in the third month, when the whole crisis broke out. She herself has hepatitis C — she was infected by chance during an operation many years ago, and she knows what it means to live with a taboo disease. Therefore, my mother understood me very well and was very supportive. It turned out that at one time she had gone through a very similar story when she was told: "Honey, I am very sorry for you, you are so young and beautiful, but prepare for the worst." Of course, all doctors are different, everything very much depends on the awareness and sensitivity of a person, but unfortunately there is a lot of such insensitivity around.
Helena
HIV-positive, husband is HIV-negative
mother of two children
I learned about the diagnosis of HIV in 2010. For me it was so unexpected that I could not immediately compare the similarity of the concepts of "HIV" and "AIDS". Thoughtlessly thinking that I only have HIV, not AIDS, I went to confirm the diagnosis in the AIDS center. There they explained to me in detail that AIDS is something that may or may not happen to me, as there is ARV therapy. For me, then it was still not at all clear, but it inspired hope. I became even less anxious after a psychologist at the AIDS center told me about the possibility of having healthy children - this was very important to me.
I am a lucky person, so in my environment those people who do not consider it necessary to stop communicating with me because of the diagnosis. These are people who seek to know the true information, and not to live by myths and fables. From the very beginning, I honestly told my parents about my diagnosis, close friends, and later on the TV screen - openly to the public. For me it was scary and exciting, but lying to me is worse. As a result of the conviction was not.
At the same time, the HIV diagnosis at first dramatically influenced my personal life. All partners during the time I had HIV, I immediately informed about the diagnosis. Most often on the Internet, to be bolder and so that a person has the opportunity to google what HIV is. As a result, the reaction was different, but it is quite natural. Someone stopped talking, someone continued, but only in a friendly format, and someone invited to a date. At some point, I decided that I would only build relationships with an HIV-positive partner, so as not to be rejected. I constantly heard from various HIV-positive people that someone had abandoned them because of a diagnosis.
Deciding to try a relationship with an HIV-negative partner because of all this was difficult: besides, I was worried about my partner’s health, although I knew that ARV therapy (which I had been taking for a long time, and quite successfully) reduces the risk to a minimum. His first negative HIV test showed that fear was in vain. The risk of infection, of course, remains, but experience shows that it is really minimal.
In general, in my case, everything went well until I found out that I was pregnant. It was then that I felt for myself that the diagnosis of HIV is not just a medical diagnosis, but a reason for some medical workers to show their inhumanity and professional illiteracy in full. To concern for their health, fear and anxiety were added to receive a denial of medical care at the most inopportune moment. Of course, with time and experience these feelings became less acute, but they remain somewhere deep and very quiet. After that, the diagnosis became harder for me many times.
During my first pregnancy, the doctor in the antenatal clinic repeatedly showed me a negative attitude, asking questions in the spirit: "What did you think, planning a child with such a bouquet?" After such repeated incidents, which invariably brought me to hysterics, I turned to the head of the department with a statement to change the doctor. It was accepted because the arguments were valid, after which another doctor continued to observe my pregnancy.
In the second pregnancy, a similar question was allowed by the ambulance paramedic, who openly asked the question: "Why did you become pregnant? You already have one." To this question, I reasonably answered that the risk of infection is less than 2 percent of the information obtained during participation in the Conference on HIV and AIDS in Russia (I personally chose the natural way of fertilization in both cases, since other methods are not sufficiently available). The doctor did not find an answer to this argument, except for the gloomy quiet: "Sorry, but I had to tell you."
After this dialogue, I also wrote a written complaint and sent it in electronic form to his management. The secretary called me and very politely inquired about my state of health, sending me in writing, however, a reply in the form that "the necessary measures of medical care were provided." That was quite enough for me, since at that time I did not have the time or energy to write to the prosecutor’s office.
Actually, the most difficult thing during pregnancy was psychological pressure from medical specialists. There was a case when a doctor in the office shouted so that it was audible outside the door: "Yes, you have AIDS!" Because of such situations, I began to develop emotional immunity, callousness - I forced myself to stop reacting to such manifestations, driving all emotions inside. Probably, therefore, the opposite cases, when the doctor showed a very careful and humane attitude, caused me to wonder, bewilderment and desire to cry.
Compared to this, all other features of pregnancy management - the need to take pills for preventing HIV transmission from me to the child and testing for immune status and viral load - were not at all burdensome. All other procedures were exactly the same as during pregnancy without HIV infection: the same vitamins, the same tests, the same recommendations of doctors to monitor weight, and so on. In addition, during childbirth, I was prescribed an IV drip with ARVT, and in the first ten days - a child. All these three stages of action protected my child from infection. I performed them and felt quite calmly, especially during the second pregnancy, when I clearly saw that it works, using the example of the first baby.
I decided to have a second child three years after the birth of the first, when I met my second husband: we decided that two children are even better than one. The state of health was still as good, and the doctors had no "contraindications". Everything happened the same way as the first time, only the difference is that there were fewer experiences and doubts.
The main thing that both pregnancies have taught me is that in a pregnancy planning situation with HIV, in order to make an informed and correct decision, access to reliable information is necessary. It is necessary to rely not on the opinion of others or individual doctors, who may also be mistaken, but on scientific facts based on statistics. And they show that the risk of infection is minimal when taking ARV therapy, and my personal experience confirms this.
Therefore, in 2013, after a course of training lectures, I began working as an equal consultant. For me, it was not so much a job, as a personal attitude and aspiration: I wanted to help people who are faced with a HIV diagnosis through emotional support, legal assistance and the provision of reliable information. At the same time, I continue to engage in counseling, despite the presence of children, just the format has changed from personal meetings to online. I still strive to help as much as I can, but more and more often people solve their problems on their own, they just need to be helped with a kind word and personal example.
For help In the preparation of the material, the editorial board thanks NP "EVA" and personally to Irina Evdokimova
Photo: Nojo