By now you’ve probably all heard about the baby who was born with HIV in rural Mississippi, and now, at 2 1/2 years old, is HIV-free. The child was given an aggressive round of retrovirals upon birth — s/he was born prematurely to a mother who was HIV-positive but didn’t know it. The child was supposed to continue treatment, but the mother stopped coming to appointments, and the baby didn’t receive treatment for a year. Now, in a miraculous turn, the baby is HIV-free.
It’s worth noting that very few babies are born HIV-positive in the United States. Early interventions are excellent at preventing mother-to-baby HIV transmission, and most women are able to get those interventions, thanks to state and federal health programs. That isn’t the case for many developing and low-income countries. I went to Cameroon about a year and a half ago to cover this very issue, and the work that a group called UNITAID is doing to help prevent mother-to-baby HIV transmission. In places with limited financial resources, widespread poverty and lack of infrastructure, getting medication consistently to health centers is tough (and doesn’t happen), and getting people who need ongoing care to the health centers when the medicine is there is even harder. I met women who traveled many miles and for many hours, hitch-hiking and on foot and at great physical and economic cost, to get the retrovirals they need for themselves and to prevent transmission to their children — and half the time, when they showed up at the clinics, there was no medication available. Lack of access to meds, and lack of infrastructure to get women to the clinics and to consistently supply women with the medications they need, are the primary reasons why babies are still born with HIV.
The situation in the United States is significantly better, but this case clearly demonstrates that we’re far from where we need to be. I don’t think it’s a coincidence that this happened in a rural area, where getting to a health care clinic may be a challenge. It also strikes me that the baby and mom were known to be HIV-positive and didn’t get medical care for an extended period of time — and as far as I can tell from news reports, there was little to no follow-up to ensure that the baby and mother were able to get to the clinic and were compliant with the necessary treatments.
It worked out well for the baby in this case (although no word on the mother’s condition), but it’s worth asking: What resources are there for women in rural areas to get the care they need? For all the right-wing efforts to defund Planned Parenthood and for all the money and energy they’re putting into pro-life activism like picketing clinics, passing legislation to constrain abortion rights and backing far-right politicians in local elections, what’s being done by the forces who supposedly love babies to make sure that babies get care? What’s being done on a structural level to make sure that low-income people who may not have consistent access to a car are able to get to health clinics, and that the individuals working in those health clinics will understand their needs and work with social services to meet them?
On a news broadcast about this yesterday, I heard one health reporter say that the mom in this case is “not the most responsible mother.” And maybe that’s true — not getting your HIV-positive infant the care she needs definitely goes in the “irresponsible” column. But I suspect that the mom in this case wasn’t just getting her nails done and going to yoga and forgot to take her kid to the doctor for months at a time. I suspect that some combination of factors got in the way. I suspect they’re the factors that often get in the way of people receiving the health care they need: Poverty, addiction, mental health issues, physical health issues, disability, rural living, lack of access to public transportation, lack of insurance, bureaucratic barriers to health care, providers who don’t understand the complexities of the situation, unemployment, underemployment, the demands of multiple jobs, the demands of caring for children and family.
There are parents out there who are simply irresponsible, abusive and awful. But more often, there are parents who are trying to do right by their kids but who hit walls at every turn. I don’t want to speculate too much on this particular situation because we just don’t know the details (and for the privacy of the family, I hope we stay in the dark). But this would be a good time to talk about how poverty, class, and infrastructure determine very real health outcomes.