The successes — and challenges — for a new generation

October 12, 2008 

In Florence, Keith and Alicia Mack wait for a bus that will take them to New York. The married couple both are HIVpositive and felt that a move north would lead to a better life.

C. ALUKA BERRY/CABERRY@THESTATE.COM — The State

Not many babies are born with HIV in South Carolina — fewer than three a year, on average.

But young adults continue to be infected at an alarming rate, considering that so much is known about HIV/AIDS and how to protect oneself against it.

People in their 20s make up almost one-third of those newly infected with HIV each year.

Public health workers point to a certain nonchalance in people too young to have seen those whose bodies wasted away as the result of AIDS. The people they know have lived with the disease for decades, as long as they kept taking their medications.

Alicia and Keith Mack of Florence personalize both the dangers of the past and hope for the future.

Alicia is 18 and Keith, 23. Both are HIV positive, yet the young couple know that if they remain careful, they may be able to deliver children not infected with HIV.

“We’re trying to have a baby right now,” Alicia said.

In South Carolina, all pregnant women are offered an HIV test.

Often, it is during pregnancy that mothers find out they are infected.

“They’re getting this news, it’s quite heavy, and they don’t know how to deal with it,” said Rajee Rao, who coordinates services for pregnant women at USC’s Ryan White Clinic in Columbia.

One woman with HIV remembers the shock of the revelation.

“You’re excited because you’re pregnant, but then you get that mind blower that you’re HIV positive,” said the woman, whose son was born HIV positive 17 years ago. “That throws your whole world into a different cycle.”

Some women fear they will have to terminate their pregnancies but perinatal case managers help them realize they can deliver healthy babies.

The mothers begin taking medications, usually during the second trimester. The drugs can lower the risk of newborn infection from 25 percent — without drug therapy — to less than 2 percent.

Medications and careful monitoring can lead to drastic drops in the levels of HIV in the body to undetectable levels. The lower the amount of virus in the mother’s body, the lower the chance a newborn will be infected.

Most HIV transmission from mother to baby occurs during labor and vaginal delivery when membranes rupture.

Because of that, some women undergo Caesarean sections. Mothers also receive an infusion of the anti-AIDS drug AZT during labor and delivery.

All prospective mothers also receive an HIV test in the third trimester. That’s because some who initially tested negative might since have acquired HIV.

Newborns are tested for HIV and given AZT for as long as six weeks. Babies are tested again at 3 and 18 months, and given antibiotics.

Mothers are advised not to breast-feed.

After birth, some women remain religious about taking their medications. Others don’t.

But Pat Derajtys, a nurse practitioner now retired from the Ryan White Clinic, said that those who do keep up with their medicines often try to resume normal lives, pursuing goals they once had set aside.

Alicia and Keith Mack know they can live with HIV — one of Keith’s uncles has survived for 20 years and is doing well.

“I grew up with it,” Keith said. “It didn’t bother me.”

For her part, Alicia wants to have two children and adopt others — a hopeful future after being infected with HIV during a sexual assault.

The Macks count on HIV medications — Alicia does not yet take any — to help them build a healthy family but realize their babies will face a small chance of infection.

That is a chance they’re willing to take.

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