HIV Infected Mothers Having Babies - Essay Example

HIV Infected Mothers Having Babies Though health care workers, social workers and community services are expected to maintain objectivity when serving the public, it becomes a greater challenge when those they serve suffer from illness which causes moral debate and controversy. This is especially true of those infected with HIV. Demographics for the virus have changed over the past decades, from affecting mostly homosexual men and IV drug users to currently affecting heterosexual women. Because more women are infected with HIV, there is dilemma for public servants in helping HIV positive mothers have babies. Some believe HIV positive women should not have babies at all. Others would rather not see babies Born to HIV mothers become infected, but realize that as human beings those women wish to have normal family lives as others do. For some women, the idea of having a baby with a positive HIV status is unthinkable. They would not want to take the risk of transmitting the virus to the baby. They also may fear that spouses or other family members would not want to care for an HIV positive baby after the mother’s death. Other women believe having a baby where there is a high risk of birth defects is ok, but not having a baby that might get the HIV virus. Personal views stem from socially acceptable norms that accept babies with birth defects more than those with HIV. Other women believe that regardless of the risks, they have a right to bear children and have a family just as much as the next woman. Women in the United States are not prohibited from having babies when they are HIV positive. Interestingly, in Botswana some officials discourage women with HIV from having babies “claiming that they are not fit to take care of a child or that they will automatically transmit the virus to the infant” (Doyle). Women are often shunned by locals who know they have the virus, when they decide to have children. This is surprising as infants are more likely to die in HIV Infected Mothers Having Babies 2 their first year of life due to unsanitary water and poor nutrition. Cultural Relativism is a theory that bases its assumptions on the premise that what is normal and acceptable for one culture is not necessarily the same for another culture. Further, what one society may consider wrong or untrue is not wrong for another. Considering this, at first it seems startling that those living in Botswana react so negatively to HIV infected women having babies. When compared to the other risks to infants in their first year of life, HIV almost pales relative to the other health issues. The theory applied with this reasoning does not work. However, HIV is a relatively new disease and one that most in Botswana know ca be prevented by abstinence from sex or use of condoms. Perhaps poor nutrition and unclean water are more accepted as facts of life that cannot be changed by the individual. Relative to these facts, HIV is controllable. Those who provide medical care do not feel the same way. While they believe that education and condom use can prevent HIV, they also know that most can not afford to use condoms. They also know that water treatment, plumbing and better nutrition are also aspects of life that can not be afforded. Workers do encourage medical treatment and HIV testing. They educate on the treatments available and the best ways to feed infants of HIV mothers. It would seem that women of very different cultures and lifestyles feel the same way about HIV mothers having babies. Cultural relativism cannot be applied in such an instances either. Differences do exist though, in individuals within the various cultures. Norms are established from the society in which we live. Norms are also established from our families and social peers. Those HIV infected mothers who do choose to have babies may do so as a result because of familial and peer influences. The United States has become extremely diverse in culture, so perhaps HIV Infected Mothers Having Babies 3 cultural norms reflect that diversity. Given such differences, Cultural Relativism does explain why some HIV infected mothers choose to have babies despite the risks. This notion can also explain why some health care workers are adamantly opposed, while others are more accepting and encouraging. Health care and community workers are generally educated in the risks and transmission rates of HIV mothers to infants. All have some knowledge of prevention, treatment and social implications. Some may come from large families or those where a family member has suffered from an ongoing illness. Their views are shaped by how illness is viewed or dealt with and even the language that is used in communicating with the ill or disadvantaged. Other health care workers come from families where illness is considered a sign of weakness, and those who suffer are treated accordingly, with little encouragement or hope. They may view ongoing illness as a strain on families, with little hope for the ill person living a normal life. This may serve as the motivation to work in health care, hoping to rid the world of all disease and misery. Such persons often keep their true feelings hidden, except with cases they view as extreme, such a HIV infected mothers choosing to have babies. They may even join crusades to try and prevent such women from having babies, either by refusing to treat them or by do not come in contact with such persons. In both examples, Cultural Relativism explains the opposing views and actions. Deciding whether it is right or wrong to help HIV infected mothers have babies becomes a matter of individual choice, based on experiential events, rather than based on moral standards. Those who have difficulties based on moral views see the situation as one of the HIV infected mother doing right or wrong. They may view to process of conception with an HIV infected partner as wrong or may be uncomfortable with the HIV Infected Mothers Having Babies 4 whole subject. Cultural beliefs from parents and peers also shape views in those instances. What is right or wrong again becomes relative, based on moral beliefs shaped by family and peers. Physicians may struggle with questions such as whether they should help bring Children into the world who may become a burden to society or become orphaned when infected parents die. They may wonder whether not being born at all is better than dealing with such obstacles. According to Bioethics Professor Jeffrey P. Kahn, “We can see that offering a way to decrease the risk of HIV spreading to partners and to babies does not necessarily condone risky behaviors that lead to HIV infection.” Dr. Kahn goes on to explain the physicians can not prevent them from trying to have children. He does believe that helping to reduce this risk is the best approach a physician can take. Dr. Kahn’s explanation does offer some sensibility in understanding the situation. Physicians may not prevent IV drug use, sexual activity with an infected partner, or pregnancies related to sexual activity. What physicians can do is take measures to reduce the risk to babies of HIV infected mothers by offering treatment, educating them on the risks of breastfeeding and providing the least risky delivery options. Such actions begin to feel more like a utilitarian philosophy that the greatest good for the greatest number is achieved in reducing risk. It can be argued that a true utilitarian approach might go further in preventing HIV entirely by adopting legislation that requires sterilization or abortion. This is not possible though, as many in our society view abortion as wrong. Subsequently, the choice for abortion or sterilization that some mothers may make becomes relative to personal views. To enforce sterilization or abortion becomes a HIV Infected Mothers Having Babies 5 moral issue forced on others. Just as some say the right to choice of abortion and birth control is necessary, opponents say that all abortion is wrong. There are many moral views of such actions. Society does not take Utilitarian action through legislation with other issues such as homelessness and poverty. If we adopted policy that provided the greatest good for the greatest number to all issues, they would be greatly reduced or eliminated from society entirely. It is Cultural Relativism that helps us deal with issues of poverty and homelessness. We become accepting of the fact that some will earn less relative to others, based on many factors such a work behavior, education and ability. Treatment for HIV infected mothers should therefore be approached with the concept that some people in our society will experience better health than others. Due to differences in family backgrounds and life experiences, some will take more risks than others. This does not imply that we should avoid education to teens and young adults about HIV infection and use of condoms. Avoidance will not make such problems as IV drug use and HIV infection go away. It is hardly practical to enact legislation that would make unprotected sex a crime, regardless of how some might feel. “It is difficult to say that any obstacle is so great that it would be better not to be born” (Kahn). It is also just as difficult to decide who should reproduce and who should not. We can say that pregnancies of HIV infected women should be prohibited, and enact laws that force them to be sterilized. Once such action is taken, it will become more difficult to determine where boundaries should be set. We may then want to prohibit mothers who have had multiple births resulting in birth defects from having children, to prevent future death or ongoing suffering. Suffering is also relative in that some cultures and families more readily accept childhood death or ongoing illness as part of life. HIV Infected Mothers Having Babies 6 Our applications of Cultural Relativism today are not nearly as rigid as those of philosophers such as Protagarus, who stated “ If the way things appear to me, in that way they exist for me, and the way things appears to you, in that way they exist for you, then it appears to me that your whole doctrine is false" (Ross, 2000). I can say that HIV kills people because I believe it does. Others can say that HIV does not kill people if they do not believe it does. Anyone who lives in a population where they can see the effects of HIV knows it can cause death. Many of those living in Botswana understand, just as most in the U.S. understand that HIV is potentially fatal. There is a truth to my statement that is proven by the number of HIV related deaths in the U.S. and Botswana. The truth does not mean that Cultural Relativism does not apply here. It means that the theory is not applied to knowledge or facts, but how we interpret them and what we should do with the facts were are faced with. One HIV infected mother may look at her diagnosis as yet another hurdle or obstacle to be dealt with in life, like poverty, violence, global warming, food borne illness and cancer. Another HIV infected mother will see such diagnosis as a death sentence. She will not want to bring a child into the world only to lose its mother and face a lifetime of illness. There are mothers who do not have to make such decisions, but assert the course of action they would take if they were in the shoes of those HIV infected mothers. When faced with reality, many women who become HIV infected will make very different decisions than previously indicated. When faced with a situation, more information is gathered, knowledge and actual facts are presented. Discovering that HIV is not necessarily a death sentence may sway their decisions, though in some cultures the knowledge that an individual who has tested positive for HIV “is harmful to marriages and hastens death” (Jeche, 2000) is a common response. HIV Infected Mothers Having Babies 7 The Zimbabwe Aids Prevention Project conducted focus groups with nurses in 2000 to obtain their views about Aids testing and prevention activities. Because of the cultural beliefs that locals held, in that learning that an HIV test was positive would actually lead to death much sooner, nurses “did not see a role for HIV testing in a curative encounter. Few saw learning of a positive test result as an opportunity for prevention” (Jeche, 2000). The view of the local population that knowing one is HIV positive will bring more harm is true to them, as they relate positive results with certain death. It is the theory of Cultural Relativism that allows them to make such assumptions. They may not want to believe in facts surrounding the transmission of HIV because death is common in culture anyway, from a variety of nutritional and viral illnesses. In this case nurses may be correct in that testing and treatment or planning will serve little purpose, as their culture believes in neither and will not likely cooperate with testing, treatment and prevention efforts. Women often enter into relationships thinking that what happens to other women will never happen to them. They may live without much fear or suffering on any level. Their partners will never stray because they are such decent persons of character. Often they do discover later in the relationship that their partner has been unfaithful is stressful, yet they work through it and go on. They fail to ask about condom use out of fear or out of the whole unpleasantness of the ordeal. Having to live with the reality of discovering they are HIV positive and making decisions about whether to have babies causes many women to see the issue from an entirely different perspective. All their cultural beliefs and views may be overlooked. Those who previously looked down on HIV infected mothers for having babies may change their minds. They become set on a course for their lives that they previously HIV Infected Mothers Having Babies 8 planned and see this as a major challenge, yet one that is not insurmountable. In such instances decisions become relative not to cultural values, but to situations brought about by the insubordination of their cultural values. Health care workers may be against HIV infected mothers having babies due to Assumptions that they routinely participate in activities that put them at risk. There is often a barrier that workers use in which they identify “us” as those who know better and stay away from unsafe practices, and “them” who disregard safety and do not care enough to make lifestyle changes. They often ignore the fact that HIV can be transmitted with one instance of instance of unprotected sex or with one dirty needle. Several studies of health car workers have shown that many have experienced at least one needle stick, admittedly due to their own carelessness. Some have also admitted to having unprotected sex with a partner whose HIV status was not known. What this shows is that separation of workers and those they care for is often easier when barriers are established. They do not necessarily think they are better, but the barriers help them to step away from the world they work in every day. Cultural Relativism allows those who help the HIV infected mothers and their babies to compare their lives and separate themselves into a different world or culture because they are not routinely participating in risky behaviors. Given the examples of differences in cultural beliefs and experiences, help for HIV infected mothers in having babies should be approached on a case by case basis. Certainly if help is sought it should not be denied on the basis of lifestyle or risk. It is ultimately better to offer some treatment and at least help prevent transmission to the baby by treating the mother with antiretroviral drugs, helping decide the best delivery options and teaching the risks of breastfeeding. Mothers who are HIV positive and HIV Infected Mothers Having Babies 9 not yet pregnant, but desire to have children should be given as much information as possible. Health care workers should not make suggestions as to whether or not HIV infected mothers should have babies. Mothers will make the decisions based on information provided, as well as on cultural beliefs or views. References Doyle, N. Making the Right to Have a Family in Botswana a Reality. Human Rights Tribune. 11,1. Jeche, M., et al. (2000). Health Worker Attitudes Toward HIV Testing in Primary Care Clinics in Chitungwiza, Zimbabwe. Kahn, J. (2000). Risky Business? Helping the HIV Infected Have Babies. Journal of Andrology. 11,1. Lerner, M. (1999). Helping Couples With HIV Have Babies: A Medical Dilemma. Minneapolis Star Tribune Online. Retrieved July 27, 2007 from http://www.aegis.com/news/ads/1999/AD991210.html. Ross, K. (2000). Relativism. Retrieved July 27, 2007 from http://www.friesian.com/ History.htm. Read More