Guangzhou gynaecologist Xuan Qingshan , 44, has helped more than 30 HIV-positive women have babies in the past nine years as a doctor at Guangzhou's Women and Children's Hospital. He shares the fears and joys of his work.
When and why did you start helping HIV-positive, expectant mothers?
I started helping HIV-positive expectant mothers in 1999 and have helped at least 30 deliver babies. My first patient, a young migrant worker and hotel attendant in suburban Guangzhou, had been led into drug abuse and acquired HIV. She had been turned down by many hospitals in Guangzhou before appealing to the city's health bureau for help. She finally gave birth to a strong, healthy baby after effective medical intervention. HIV mothers who encounter an unknown future and social discrimination are brave. About 90 per cent of HIV-positive pregnant women choose abortion.
My colleagues and I later started to pay close attention to HIV-positive expectant mothers and tried to stop mother-to-child transmission through medical intervention. Statistics show that the mother-to-child transmission rate can be cut from about 40 per cent to as low as 2 per cent. Our records show some 49 babies delivered by HIV-positive mothers in Guangzhou all tested negative for HIV after being observed by us for two years.
What have been some of the most memorable moments?
There are so many. I have seen a 29-year-old HIV-positive expectant mother quit drug abuse for the sake of a healthy baby. She twitched and vomited all day and almost every day for eight months. To avoid infecting their babies, all HIV-positive expectant mothers suffer great torment from anti-virus pills, with symptoms such as dizziness, anaemia and liver damage. Love and understanding shown by their families often affects me. An HIV-positive expectant mother found she had acquired the virus through a blood transfusion during an antenatal check-up. Huge support from her husband and family helped her to complete the pregnancy.
Are you worried about the risk of infection?
Of course. We wore motorcycle helmets, diving masks, raincoats and boots for the first surgery in 1999, fearful of HIV infection from mothers' blood and amniotic fluid.
Professional clothes to better protect doctors and nurses were introduced in 2000 but they are far from adequate to completely remove the possibility of transmission. Any carelessness could put surgeons wearing standard rubber gloves at risk. I remember a young nurse who had cut her finger during an HIV-positive mother's delivery crying that she was too young to die. Fortunately, the two gynaecologists and several nurses who have been cut during HIV-positive mothers' deliveries have all tested negative.
Now, we never pass around knives because even a tiny cut can kill. Anti-HIV drugs are also handy in the delivery room. The pills can prevent HIV infection within four hours of exposure to the virus but it is not a 100 per cent guarantee.
What kinds of difficulties do Chinese HIV mothers encounter?
We didn't have a delivery room in Guangzhou for HIV mothers for nearly a decade after the first case was reported. All infected mothers delivered in a makeshift temporary ward. But I still regard it as progress because HIV-positive pregnant women were all forced to abort their babies a decade ago; they didn't have the right to be a mother.
The children don't suffer any less. Mothers have to wait 18 months before their babies are confirmed as either HIV carriers or healthy. Even after testing negative for HIV, children can still be refused by clinics and schools, and feel discriminated against for their whole childhood. HIV mothers with a limited lifespan can't guarantee their children a good quality of life or education. It's brutal to leave a toddler alone in the world after its parents die.
To deliver or to abort is always a dilemma. We leave the decision up to the mother and provide only a medical service. There's no standard answer for HIV mothers.
What else have you done to help them?
You can never really understand an HIV-positive mother's pain and fear. So I organise gatherings for them to exchange successful experiences and encourage each other as friends. I have received positive feedback; they no longer need our hospital's psychological consultants.
My colleagues and I now focus on medical intervention to prevent mother-to-infant HIV transmission. Two of our projects are sponsored by provincial authorities. In the future, we would like to explore the possibility of detecting whether a baby is HIV-positive before it is born.