Two-year-old Angelica Radigan playfully stomps around the playroom in a dark velvet Mickey Mouse dress. She smiles a lot and sometimes sings to herself as she pushes around the toys scattered across the floor. She often walks over to her mother, who is sitting on the floor watching her, and plops down in her lap for a few contented moments.
Outside the playroom, physicians walk by on their rounds. Some stop by to peek in and smile at Angelica and her mother, Patti. Both are familiar faces to the staff at the Bay Area Perinatal AIDS Center (BAPAC), a University of California program based at San Francisco General Hospital. The center was founded in 1989 and was one of the first programs in the country to provide coordinated care and services for HIV-positive pregnant women and their families. It is the only center of its kind in Northern California, attracting women from hundreds of miles away.
More than two years ago, Radigan came to the center for pregnancy counseling. Radigan, a 38-year-old former prostitute and heroin addict, decided she wanted to have her baby even though she was HIV-positive. It was not the first time she faced the prospect of giving birth while infected with the AIDS virus.
“Before Angelica, I had gotten pregnant a few months into my recovery program and soon after I got married,” Radigan said. “The methadone clinic I was going to sent me to BAPAC, and they were real supportive and loving and told me I could have a baby if I wanted, but they also explained the risks.”
After an initial counseling session, the center sent Radigan to see an outside doctor to confirm her pregnancy.
“I was about 35 then, and this doctor just pretty much told me not only was my baby going to be HIV-positive, but because of my drug history and my age, there would also be chromosome damage,” Radigan said.
After seeing the doctor, Radigan returned to the center, where staff again assured her that it was her choice and the center would stand behind her whether she decided to have the baby or an abortion.
“I was just not ready,” Radigan said. “My support group was on my back, saying that I was trying to kill my baby. And I mean, my self-esteem was already in the toilet, so I terminated the pregnancy.”
Radigan soon relapsed and ended up on the streets another year.
“I almost lost my husband, I lost my apartment, all this stuff I had built up while in recovery,” Radigan said. “After I had the abortion, I just lost everything because I was thinking I’m HIV-positive, I can’t have kids, I can’t have a life.”
Finally, Radigan decided she did not want to die out on the street, so she once again entered a rehabilitation program and reconciled with her husband. About six months into her second recovery, she got pregnant again.
“This time, it wasn’t an accident,” Radigan said. “I wanted to have this baby. I knew a lot more about the virus at that point and I just kept hearing the nurse I spoke to years before at BAPAC, telling me I could do it.”
Dr. Karen Beckerman, director of the center and a mother of three, acknowledged there’s a lot of public uneasiness over HIV-infected women who decide to have babies.
“There’s a lot of mixed feelings and a lot incorrect information out there about what happens with HIV disease in pregnancy,” Beckerman said. “We know that HIV disease is not worsened by pregnancy, and we also know that most babies of HIV infected mothers will not be infected by the virus, even when their mothers do not receive any drug therapy.”
According to the U.S. Centers for Disease Control and Prevention, the rate of transmission is about 25 percent for women who do not receive any anti-viral drugs during pregnancy.
“Very few people understand that, and even fewer people understand that with the anti-retroviral drug AZT alone, you can decrease that transmission rate to about 8 percent,” Beckerman said. “In other words, 11 out of every 12 babies born to women taking AZT alone would deliver uninfected babies.”
Researchers at the center took part in the landmark national clinical trial four years ago that proved AZT during pregnancy and delivery greatly reduced perinatal HIV transmission. Although the experiment was highly controversial when it began, the trial proved so successful that AZT became the standard therapy for HIV-positive pregnant women in the United States.
A few months ago, health officials in the U.S. and Thailand announced that smaller, and therefore less expensive, doses of AZT during pregnancy reduced mother-to-child transmission by half. The results now offer hope of extending perinatal prevention to HIV-infected women throughout the developing world.
Until 1996, BAPAC only offered AZT as an option for HIV-positive pregnant women. But the drastic reduction of infected babies prompted the center to include combination therapies that are based on new national recommendations for the care of HIV-infected adults, Beckerman said.
“As concerned as we were with transmission, we realized we were bringing into this world a very significant number of babies who had a very high chance of becoming orphans before their 10th birthday — in fact, the chance is probably about 95 percent,” Beckerman said.
She said the new, intensive combination therapies presented the center with a difficult decision: Should it offer expectant mothers drugs with unknown effects on pregnancy and the developing fetus?
“We decided that this was a decision that our clients really had to make for themselves, and we would serve as educators, as counselors and also as caregivers and make all of these drugs available to our clients,” Beckerman said. “But we also had to focus on the fact that it was our client’s decision, we weren’t the ones who would have to live with the decision after the baby was born.”
As it turned out, almost all of the center’s patients chose to take the new anti-retrovirals.
“This has had an extraordinary outcome because while we were primarily offering these therapies to our pregnant clients so they could live to see their child’s high school graduation, what has also happened is that the rate of transmission of virus to the baby has become immeasurable,” Beckerman said.
In the last three years, 58 babies have been born to HIV-positive women under the care of the center, and none was infected with the virus. All the babies, including Angelica Radigan, are monitored carefully for the virus until their second birthday.
“While I am so glad we have been able to change things for our patients, on the other hand, I am also very concerned about the mother’s health. I really want these babies to have moms when they grow up,” Beckerman said.
“Not knowing what the long-term effects are with these drugs is kind of scary,” Radigan said. “But I have to do something — take care of myself and stay healthy — that’s the main objective. Aside from getting tired like most mothers, I really feel great — very positive about myself and my life. I mean BAPAC has done some wonderful thing — all those women with no positive babies and now, I’m going to be around to see my baby have her children. I really believe that!”
Beckerman is naturally more cautious when it comes to making such statements.
“Our ultimate goal used to be to prevent transmission from mother to child,” Beckerman said. “Now, our ultimate goal is to get mom to her child’s high school graduation. We still don’t know if that is an achievable goal.”
