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HIV tests urged The 38-year-old woman had no idea she was at risk for AIDS when she was pregnant with her second child.
during pregnancy,
even if risk is low
'We can largely prevent
transmission from an infected mother
to an infant,' Kapiolani's
specialist saysMore isle women getting AIDS
By Helen Altonn
Star-Bulletin"I didn't even know I was sick. I have been with five partners in my whole life. One of the gentlemen I was with had it apparently."
Michelle said she had the disease for four years, but it wasn't diagnosed until May when she began having symptoms. Unknowingly, she had passed the AIDS virus on to her 3-year-old daughter at birth.
"As soon as I got diagnosed, I took my daughter to her doctor and said, 'please give her a blood test.' She is like a miracle baby at Kapiolani (Medical Center for Women and Children)."She has only had two colds in her life; she has never been sick. She's unbelievable right now. Dr. (Marian) Melish has done a fantastic job in treating her right away."
Melish, pediatric infectious disease specialist at Kapiolani, said she has seen an increase in HIV-exposed infants, particularly in the last year.
It's partly because more women are being screened in pregnancy, but a large number still aren't being screened, she said. "So there are probably many more out there."
Screening is important because a mother's health can be improved if the disease is detected before symptoms develop, Melish said.
Also, "We can largely prevent transmission from an infected mother to an infant. Whether we intervene during pregnancy, at delivery or after birth. This is excellent news -- one of the best bits of news we have.
"It used to be the only way we could prevent HIV infection in the mother was to tell the mother not to breast-feed," Melish said. "Now we can treat the mother during pregnancy and during labor and treat the infant right after birth."
Mandatory HIV screening?
Michelle declined a test for HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immunodeficiency Syndrome) when she became pregnant because she had been tested the previous year and it was negative."This was the last thing I thought I would ever have," she said, urging pregnant women to be tested even if they think they don't have the virus.
She feels screening should be mandatory to protect children born to infected mothers, noting that some of her friends don't use protection, and some who are married could be infected by their husbands.
"It's not something they should play Russian roulette with."
Melish said there was "limited value to screening in the past. We could detect the disease earlier in the baby and tell the mother not to breast-feed, but we really couldn't prevent it."
In recent years, however, multiple means of prevention have become available, she said. New drugs given to the mother and baby can cut the risk of infection from one out of four babies to fewer than one out of 10, she said.
More recent studies have shown the risk can be reduced further if the mother is treated more intensely during pregnancy, Melish said.
But screening isn't required and tends not to be done as often in private offices, possibly because doctors think asking expectant women to be tested would offend them, Melish said.
She would like to see prenatal HIV testing become a standard of care for pregnant women, done at the same time as other blood tests.
A state task force worked with the Hawaii Medical Service Association and other groups to make screening more reasonable and part of routine prenatal care, Melish said. "But it has not been universally implemented."
Insurance should cover it, she said, because "to prevent a case of HIV infection prevents them from spending a large amount of money on an infant."
Requiring the test would raise civil rights issues but it should be offered, she said, noting there are barriers even to doing that.
"A lot of counseling needs to be done. Some people are not willing to spend time in counseling or else feel that the patient is not at risk."
At-risk profile unreliable
But the majority of infected women no longer fit the profile, she said. "They've never been drug users. They're not aware they've ever had a partner who was at high risk by being a drug user or having sex with men."So, like Michelle, most women aren't aware that they have risk factors, she said.
"Everyone thinks of prevention in avoiding drug use and clean needles," Melish said, adding that Hawaii is fortunate to have a clean-needle program that has helped slow the spread of the disease.
"Condom use is still important and knowing your sexual partner and knowing your risk," she said.
"It's also important to know there is very effective means of drug treatment that will prevent HIV and make the mother more healthy ... Now people are living with AIDS quite well, mothers and children, and men."
Consequently, she urges pregnant women: "Don't be offended if your doctor thinks you need an AIDS test."
Medications can be toxic
Michelle went to the doctor because she had thrush, "like white spots inside my mouth." She was sent to the hospital for a bone-marrow test to determine whether she had cancer.She said she raised the possibility of HIV infection. "I said, 'Don't you think I should be given an HIV test?' I understood what thrush was -- a symptom in the mouth that can tell you straight off you're looking at this disease.
"They weren't even thinking about it. I wasn't high risk. My gynecologist knew my background ... It just wasn't anything you would think I had."
By the time she was diagnosed, Michelle said, "It was pretty much considered AIDS then, not HIV. I went right into pneumonia and was in the hospital 10 days fighting for my life."
She said she's "feeling fantastic now" and her daughter is "like any normal healthy child, more normal than my (teen-age) son, who had a chronic ear infection."
She takes seven pills plus iron. "I do a balancing act now. The medicines can be really, really toxic."
Her daughter takes the same medicine, swallowing four pills in the morning and four at night.
"She was extremely lucky," Michelle said. "At day care, kids are always sick. She doesn't get sick.
Teaching from experience
She traced the AIDS virus back to the man who infected her."He didn't know he had it," she said, explaining that he got it from another woman.
"Angels were watching over me" the past three years, she said. She hasn't been in a relationship and hasn't spread the disease, she said. "It's bad enough that it is spread to my daughter.
"I can deal with the fact that I have it, but now I have to deal with the fact that I gave it to my daughter."
She has become a Life Foundation volunteer, sharing her experience in the hope of preventing other women from going through the same thing.
"Since I have received the virus, I feel this was my calling. It sounds crazy but it's my destiny.
"In a way, I look upon this whole journey as a gift. This has been such a learning experience. I have a really good feeling about life."
AIDS cases among island women are gradually increasing, with more than half attributed to heterosexual contact. More isle women getting AIDS
Star-Bulletin staff
The percentage of cases among women has increased from 3 percent (16 out of a total 481) before 1990 to 5 percent (59 of 1,085 cases) in 1990-1994 and 9 percent (70 of 779 cases) in 1995-1999.
A total of 90 male and female cases were reported up to Sept. 30 this year. Of those, 13 cases -- 14 percent of the total -- were women.
Of 137 female AIDS cases from 1983-1998, 75 (53.2 percent) were from heterosexual contact and 45 (32.8 percent) from injection-drug use.
The percentage of male AIDS cases has declined from 95 percent (1,026 out of 1,085) from 1990-1994 to 91 percent (709 of 779) in the 1995-99 period.
Source: State Health Department