Jamison Hughes can smell dinner simmering, and he is hungry. But his mother is distracted by guests. Jamison, 4, zooms from one parent to another, disappearing and reappearing from the room until he emerges with a wrapped snack that he drops onto his mom’s lap. She gets him a tangerine to munch on instead.
Jamison’s father then sits him down at the dining table with a package of crayons. The two knock heads over a coloring book, the strawberry-blond boy a carbon copy of his dad.
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Kelli Hughes calls Jamison her miracle baby. When she was diagnosed with HIV, her doctors didn’t think she would make it to her wedding a year later, much less to a point where she could have children.
But a decade after her diagnosis, Hughes is six months pregnant with her second child. Another boy, she is told. And chances are, he will be HIV-negative, like his brother.
“Women are feeling well. They’re living longer with the disease; they have confidence that they’re going to be alive to see this child grow,” said Dr. Judy Aberg, director of HIV services for Washington University’s Department of Medicine. “People are trying to live normal lives.”
Thanks to recent advances in drugs used to treat HIV, the virus that causes AIDS, infected people are more easily able to suppress the virus in their immune system, a key to reducing the transmission rate from a mother to her baby.
Aberg said the risk of transmitting the virus from a mother to a child can be as low as 1 percent–but only if the mother is on medication during pregnancy. Without prenatal treatment, the rate increases from 25 percent to 40 percent. But research has showed that even women who forgo treatment can receive intravenous medicine during labor and still significantly reduce the chance of transmitting the virus.
About 6,000 to 7,000 women with HIV give birth each year, resulting in more than 300 infected infants, according to estimates by the Centers for Disease Control and Prevention. Early identification of the virus is crucial. The centers recommend that HIV screening to be part of the standard set of tests for expectant women. Typically, only federally funded health clinics make HIV testing routine.
Many women learn that they are HIV-positive during prenatal care. Sometimes, they are diagnosed during a later pregnancy and already, unknowingly, have infected an older child.
But an increasing number of women have long known their status, and most intentionally are trying to conceive.
“I just wanted a family,” explained Ramona, 26. She and her husband, who is HIV-negative, got pregnant through artificial insemination they performed themselves. Their daughter, who turns 2 next month, is free of the virus.
Many health officials believe that stories like these are encouraging other women with HIV to have children. But they stress that Ramona and Hughes are not like all cases.
Ramona, who did not want her full name used to protect her husband’s family, contracted HIV through unprotected sex. Diagnosed in 1997, she has yet to have any complications from the infection. During her pregnancy, Ramona worried about transmitting the virus to her daughter but rarely gave any thought to whether she would be around to raise her.
“I really didn’t think about it, because I knew I was going to be around for her,” she said. “I didn’t think the worst of the worst. I thought the best of the best.”
What concerns Catherine Williamson, a nurse practitioner at a St. Louis private practice that sees the bulk of the area’s HIV/AIDS cases, is that many HIV-positive people are not realistic about their condition. While she calls it “a wonderful trend” that so many infected women are living longer and having healthy babies, “the truth is, in the real world, people are still getting advanced AIDS and still dying.”
Hughes, 34, is quite aware of this. Infected with HIV through unprotected sex when she was 18, she is resistant to many of the medications available, an increasingly common problem for HIV patients.
Hughes has experienced serious side effects to many drugs she has taken during her pregnancies. She lost more than 20 pounds because of one drug that virtually eliminated all the fat from her arms and legs. Another medication nearly doubled her cholesterol, while one other prescription burned the lining of her esophagus.
Not that she’s complaining.
Hughes, senior regional director for Express Scripts, never thought it was even medically possible to have children until she moved back to St. Louis, her hometown, in 1996. She broached the subject after her new doctor prescribed prenatal vitamins for their nutritional value.
“She said, `Most certainly. We have moms all the time that have babies that have non-transmission.’ And my jaw dropped, because I completely expected her to say, `No way. Forget it,”‘ Hughes said.
Before her diagnosis, Hughes hadn’t thought about having children. As a journalism major in college, she dreamed instead about jumping from one city to another until she obtained her goal of anchoring the evening news for a major network.
“But when your life is turned upside down and inside out and broken into a thousand pieces, certainly your priorities change, and having children was one of those things that made you normal again, and a female,” she said.
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Ultimately, it took Hughes two years before she got pregnant through artificial insemination.