The percentage of women who have been diagnosed with AIDS has increased more than three-fold over the last 20 years. Advocacy groups have started taking notice. More and more, they’re tackling HIV/AIDS transmission from a gendered perspective, pursuing programs and services related to pregnancy and female condoms.
Positive And Pregnant

Elaine Gayles is six months pregnant with her second child. But this pregnancy is different; now there is a possibility her daughter could be born HIV-positive.

“I’m scared my baby might have it,” Gayles says.

The good news is that with the right medical regimen, the risk of transmission from mother to child drops from 25 percent to under 2 percent.

Faria Farhat, a doctor at the Howard University Infectious Disease Center that Gayles visits, says preventing transmission requires vigilance on the part of the mother and her doctors. Farhat says some HIV medications “have adverse effects on the fetus.” She recommends that women talk with their doctors in advance about changing medications, even before they get pregnant.

A recent study conducted in Canada shows that not all HIV-positive women of childbearing age are encouraged to have children. Many in the study felt stigma — mostly from health care professionals.

“In our practice, I don’t think that we discourage patients[to have children],” Farhat says. “It’s their personal decision.” But she says they do not encourage women with high viral loads to get pregnant “because then the transmission rate for the infant is very high.”
‘Educate The Women’

Gayles says she’s never been discouraged from getting pregnant – not by her family or her doctors.

She’s also a member of the Women’s Collective, which actively supports HIV-positive women with caseworkers and support groups. Patricia Nalls founded this Washington D.C.-based group in 1993 to get HIV-positive women engaged with health services and with each other. The original goals inform the collective’s stance on pregnancy.

Nalls says the collective has seen women whose doctors have encouraged them to have abortions discouraged pregnancy in the first place. She says groups like the Women’s Collective have to teach women what their options are, in case their doctors don’t.

“The approach is: educate the women, educate the mothers, so that when they do get tested, they know to say to the doctor, ‘I know that I can have this baby.’”

Nalls is an HIV-positive mother herself, but she had her third child before she knew her condition. She lost her daughter and her husband to AIDS within months of each other. That was in the 80s, before there were ways to stop transmission during pregnancy. Nalls says she may not have kept her child if she had known her status. But she says it’s different now.

“If I was to be pregnant now,” she says, “I would keep my child…I know that if I do the right thing, if I take my medicine, I can stop the transmission.”
The Female Condom

But pregnancy is not the only time women can take the initiative to prevent HIV transmission.

Nalls says the female condom is one step towards female control of transmission during intercourse. The Women’s Collective is one of five D.C.-based organizations to receive funding from the MAC AIDS Fund for their female condom initiative.

This program began in March, a year after a report by the D.C. health department found that 3 percent of all District residents were living with HIV/AIDS. That’s three-times higher than a “generalized and severe” HIV epidemic, according to the United Nations and the U.S. Centers for Disease Control.

Nancy Mahon, the Global Executive Director of the MAC fund, says this report and other data helped determine the geographic distribution of the $500,000 grant. A D.C.-based group selected the recipients, who have been using the money to buy the condoms at wholesale prices and educate residents about how to use them.

The advantage of the female condom is that it’s something that a woman can wear herself; she doesn’t have to ask her partner to use protection. But Mahon says handing out the condoms wouldn’t have worked without also putting resources into education.

Abby Charles, the Female Condom Project Coordinator for the Women’s Collective, says she’s given demonstrations where women have no interest in the condoms when they walk in. But by the end, she says, everyone wants one.

“The female condom empowers women who have issues with negotiation. That is definitely a fact,” Charles says.

She noted, though, that the control the condoms offer might be out of reach for women in the most abusive relationships.

“I would never go before a group of women who have been in domestic physical violence situations and say, ‘Here is your savior to protect yourself from HIV,’” Charles says.

Nalls says condoms will still be available at the Women’s Collective, even if their MAC grant isn’t renewed.

“We feel, as a women’s organization, that we have to do that,” Nalls says.

Also, the D.C. Health Department will be subsidizing the cost of female condoms for the first time starting in January.
Protection After Conception

As for Gayles, she says she hasn’t tried the female condom yet, but she’d be willing to after the baby’s born.

For now, like other expecting mothers, she has started setting up her daughter’s pink and white room. Unlike other mothers, she also is preparing to share her HIV status with her daughter.

“I talk to my baby now and let her know. She…be kicking me. She’s like, ‘Okay, my mother’s telling me this early,’” Gayles says.

Gayles holds her tummy and tells her baby to watch out for men like her ex, who infected her. And she says she will always be supportive of her child, no matter what the future holds.

Producer / Photographer / Video: Yanina Manolova

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