With Mother’s Day approaching this Sunday, millions of Americans are wracking their brains wondering which brunch spot she’d like best, or whether to send the boxed chocolates or the bouquet of daisies. Some remember their childhood fondly while others carry some level of trauma from theirs. Bring up mothers in conversation, and you may elicit any number of reactions from gushing to silence to outright hostility. But one thing we don’t often think about is what many mothers living with HIV go through to ensure their child gets a fresh start in life.
Mother-to-child transmission of HIV is the spread of the human immunodeficiency virus from an HIV+ woman to her child. It can occur during the nine months of pregnancy, childbirth, or breastfeeding (among misinformation around how HIV is not transmitted is the often overlooked way that it can be transmitted from mother-to-child: through breastmilk). The greatest risk for transmission occurs during vaginal delivery when the infant passes through the birth canal, becoming exposed to any traces of the virus in the mother’s blood and other fluids. For this reason, mothers with HIV may be encouraged to pursue a cesarean delivery.
Universally, doctors encourage HIV testing as early into the pregnancy as possible, to lessen the chances of transmission to the fetus. If a pregnant woman tests positive, HIV medications can be quickly administered, preventing HIV from multiplying in her body and reducing her viral load. Having a lower viral load in the body reduces a woman’s risk of transmitting HIV to her child during the pregnancy or during childbirth and improves her overall health. Babies born to HIV+ women receive an HIV medicine called Retrovir within 12 hours after birth; rounds of this medication will continue for up to two months of the infant’s life, during which the mother will be encouraged not to breastfeed. Once two virologic tests show negative results (the first test taken when the baby is at least 1 month old, and the second test taken when the baby is at least 4 months old), the infant is deemed HIV-negative and taken off medication. If both tests come back positive, the child is switched from Retrovir to a combination of other HIV drugs. While all this may sound dangerous to a newborn infant, the side effects are minor and hundreds of infants each year avoid HIV transmission from the process.
In fact, HIV experts are optimistic about the current state of mother-to-child transmission in the United States. Fewer than 100 babies were born with HIV in 2015, and in North Carolina that same year, there were no reported cases. Nationwide, HIV medications have brought perinatal transmission down to less than 2%. Eliminating mother-to-child transmission of HIV in this country is a very real possibility, solely due to funding for HIV testing and access to antiviral drugs.
“The evidence is iron-clad that when people with HIV are treated and their viral load is suppressed, their likelihood of transmitting HIV goes down to almost zero,” said John Peller of the AIDS Foundation of Chicago in a recent Reuters article. “So, any kind of interruption in care is going to result in more cases of HIV.”
In North Carolina, women make up about 29% of reported HIV cases. And of that number, 61% of new diagnoses occur among women of child-bearing age (15-44 years old). With youth ages 13-24 accounting for more than 1 in 5 new HIV diagnoses, one naturally wonders why teenage pregnancies would not account for more mother-to-child transmission of HIV or other STIs.
And yet, this isn’t the case.
In a society that values its children, whom do we have to thank for this? Due to the preventative efforts by organizations like Planned Parenthood aimed at youth, teen pregnancy in North Carolina is at an historic low.
But this is where the good news stops.
Right now, the American Health Care Act (interchangeably called AHCA, Trumpcare, and the GOP Health Bill) awaits its day in the Senate. 217 House Representatives voted yes on the health care bill, including 9 North Carolina Representatives. After nearly a decade of criticism of the Affordable Care Act (or Obamacare), the mantra of “repeal and replace” has found some traction. With the loss of the ACA, what do mothers with HIV stand to lose?
- Before the ACA was passed, only 13% of people living with HIV had private health insurance and 24% had no coverage at all according to the Department of Health and Human Services;
- Medicaid is the largest source of insurance coverage for people living with HIV in the United States (KFF). Approximately 1 in 4 women of reproductive age rely on Medicaid as a means of healthcare access;
- Nearly 25,000 North Carolinians (and 2.5 million Americans) rely on Planned Parenthood for reproductive health care as preventative or primary care. This is not surprising, considering 54% of Planned Parenthood centers around the country serve low-income communities in “medical deserts”: rural or medically underserved areas;
- Women are 40% more likely than men to have mental health needs (including postpartum depression);
- While men have higher rates of substance use disorder, women see higher rates of co-occurring mental illness and substance use disorder (3.6% vs. 3%), suggesting a correlation between trauma and self-medication, among other factors;
- Under the ACA, mental and substance treatment were covered as “Essential Health Benefits.”
The AHCA (American Health Care Act), if passed, will have an immediate impact on mothers with HIV. With the MacArthur Amendment (named after NJ-R Representative Tom MacArthur), individual states would have power to discriminate openly. Under the ACA, every insurer had to offer “Essential Health Benefits” guaranteeing coverage for life-saving health services like prescription drugs (like PrEP), mental health, and substance abuse treatment. The MacArthur Amendment does away with these essential benefits, and allows insurers to determine the cost of care based on a person’s “health status.” Despite the Upton-Long Amendment–which places people with pre-existing conditions (such as HIV or depression) into “high-risk pools” and would dispense $1.6 billion in subsidies every year for the next five years to reduce their increased health care costs–only 0.0006% of Americans living with pre-existing conditions would be financially supported. Furthermore, the new health bill seeks to defund Planned Parenthood, which provides critical healthcare access and preventative HIV/STI testing to women living in “medical deserts” and gut Medicaid, which bridges the gap between low-income Americans and quality life-saving care we are all deserving of, regardless of economic status.
What does it look like when expecting mothers don’t have access to testing? What decade will we be thrown back into when teenage pregnancy rates rise again? How many babies will be born with HIV?
The reduced risk of mother-to-child HIV transmission is not a signal to stop caring. It is a rallying cry to keep, and even improve upon, the healthcare provided by the Affordable Care Act. In the weeks ahead, the Senate will decide upon the fate of our healthcare, and ultimately, the fate of our next generation. Can we end AIDS? Yes. Can we end AIDS without Medicaid, access to early testing and treatment, life-saving healthcare providers like Planned Parenthood, and mental health and substance abuse treatment considered “essential”? That future looks far less certain.
As you hug, or call, or even argue with your mother this Sunday, think about what she’s done for you. Think about the millions of mothers who put all their hearts and paychecks towards their children’s futures. And when Monday morning rolls around: fight for them. Call your representatives, talk to your friends, get angry. The future of healthcare affects the future of us, our mothers, and our own children, as mothers ourselves.
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“Oppose the American Health Care Act (The Proposed ACA Replacement).” An Indivisible guide.