January 12, 2020 – Positively Aware.
by Michelle Simek
"I have taught my daughter how to not let what other people think affect her. After I learned that myself, that is when I started to love me. I am HIV-positive and if you can't deal with that, you don't deserve me in any aspect."
- Lynnea Lawson, Los Angeles, California
Lynnea Lawson found out that she has HIV when she was seven years old—she had acquired HIV at birth. Her HIV status was outed when she was a teenager and she had to switch high schools due to serious stigma. Her self-esteem was low. She thought she was ugly and worthless. For a while, she even adopted an "alter ego" that had nothing to do with HIV/AIDS and enabled her to live a second life in denial of her diagnosis. Now, at 34 years old, she is both an HIV activist and the proud mother of a daughter who is HIV-negative. Lynnea—like the knowledge that we have today about HIV and pregnancy—has grown tremendously.
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In the 1980s and early '90s, most women living with HIV were actively discouraged from having children due to fear, stigma, and concern that they would not live long enough to raise their children or would transmit HIV to their babies. Moreover, some women living with HIV who became pregnant were pushed to terminate their pregnancy—an option that many ignored, and thus had to fight for their right to bear their child. Some were pushed into having cesarean deliveries (C-sections) to help prevent HIV transmission during labor.
In 2020 (and since the 1990's), women living with HIV can and do have babies who are virus free, not only in the U.S. and Europe but also in Africa and other continents. However, there are guidelines to prevent vertical transmission (also known as mother-to-child transmission, or MTCT):
- If the expectant mother is not on HIV therapy, she needs to start right away.
- She should take a regimen that contains two nucleoside reverse transcriptase inhibitors (NRTIs, or nukes) plus one other HIV medication from another drug class
- Treatment should be individualized for each mother, taking into account her circumstances, potential side effects, opportunistic infections, or other co-morbidities (most especially hepatitis)
- If the expectant mother gets her viral load down to undetectable—and keeps it there—the risk of transmitting HIV to her unborn baby is virtually nonexistent.
- If the expectant mother is already taking anti-HIV medication and her viral load is undetectable, she should continue taking it as long as it is safe for both mother and child (see sidebar about dolutegravir).
- Women who are pregnant and living with HIV can have vaginal deliveries! C-sections are no longer recommended but can be scheduled electively two weeks prior to the due date.
- Mothers who are living with HIV in the U.S. and Western Europe should not breastfeed. (Guidelines are different in some resource-limited countries in the southern hemisphere, where the risk of using contaminated water for formula is more dangerous than HIV due to the risk of other life-threatening infections such as cholera, dysentery, and other water-born illnesses.)
- Newborns take liquid pediatric doses of AZT for 4–6 weeks after birth as an added preventive measure (the time frame depends on whether the mother took HIV medications or not).
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Growing up
A Los Angeles native, Lynnea is a seasonal tax preparer and self-described "lifelong AIDS activist." When she became pregnant, she followed the guidelines listed above, and her five-year-old daughter, Nae'lyn, is HIV-negative.
The very first HIV test (ELISA) was approved in April 1985, but Lynnea was born the month before, so neither she nor her mother were tested. As she got older, one of her sisters, Keisha, was very inquisitive and kept asking their mother why Lynnea had so many medical visits. "I was the only one out of four kids who kept going to the doctor and having blood drawn." Keisha was relentless with her questioning and their mother, Patsy, eventually revealed the truth although "it wasn't in my mother to disclose." Patsy told Keisha that Lynnea had HIV but instructed her not to say anything about it to her sister. Lynnea remembers being outside playing while Keisha was with her, keeping quiet while she was deep in thought. Finally Keisha asked, "'Did you ever wonder why you kept getting stuck with those needles?'" Lynnea said, "I had never thought about it until she brought it up. I had never asked. I had complete trust in my mother. If my mom said I needed to take this medication, I knew I'd be okay."
Keisha's next words were: "You have HIV." Continue reading on Positively Aware...
