First HIV/AIDS interviews

Today was the first day of our more specific work outline. We will be working at the women's hospital this week. There they have one of the cleanest facilities that we have seen so far. (I suggested that it was probably because it is run by women and for women :) We toured the birthing facilities. There were three birthing rooms, 2 of those were occupied by women already in labor. They were laying on beds waiting until they would be moved to the birthing table which was in the same room. The third birthing room is reserved for people who are "unknown". That is those who haven't had any appointments prior to their labor. A lot of them are drug addicts, many HIV positive.
The Doctors here don't really understand the difference between Masters in Public Health and a Doctor. So they led us into the rooms as if we knew exactly what goes on during labors ( I have read about it, seen it on tv, but watching the real thing was a lot different!) They don't have very many "one time use" equipment or biohazard containers. They just put everything in the Autoclave and then throw the "clean" needles etc. etc. in the regular garbage and the tools back on the shelf.
We then proceded down the hall to see the women with their babies. Thay have two in each room- pairs of mothers and babies that is. I at first thought that that was pretty cool that the new moms get to be close to their babies all the time they are recovering (3-5 days here). But my host mom explained that it can also be hard because the moms are trying to recover and take care of their babies. And one baby crying wakes up the other etc. Some people have private rooms, but those cost money. Otherwise births are totally free. I think that the government pays for them all because they are trying to increase the country's birth rate.
We went through the abortion rooms on a different floor. One was just being cleaned after a surgery. Abortions were the only kind of contraception used during Soviet times so many women here have had 4 or 5 abortions. They remain the most frequently used birth control method in Russia, 2 abortions for every live birth. People say that this is because of the cost of oral contraceptives and condoms. People can't afford them or at least not on a regular basis and abortions are free.
The most absorbing moment of my day was an interview with an HIV positive girl who just married her boyfiend and is 5 months pregnant. She was clearly a sweet well educated girl. Her boyfriend tried drugs a few times in High School before she met him. She got HIV from him and found out three years ago. I thought she must have found out when they did her required pregnancy HIV test. But actually HIV tests are "required" for almost every medical procedure here. We asked each other questions... To her we explained that she was misinformed about the chances of her baby being born with HIV. At the clinic in Samara where she goes to get her medecines they told her that her baby would have an 80% chance of getting HIV! It's actually more like the opposite. As I mentioned before so far all of the babies born in Chapaevsk to mothers who followed their ARV treatment regiments have all tested negative. THere is only about a 5-9% chance that her baby will be born with HIV. She was obviously really relieved to learn that her baby would probably be normal and healthy. She is taking the Russian generic medecine called "Timizite". It is thought to have more side effects than AZT, but apparently is a pretty close copy. It's not recognized, by the government either for copyright reasons so I don't really understand why they were using it at the clinics.
The awful sad part of the interview was the recognition that although pregnant women are given free ARV treatments once they give birth and get their final treatments they no longer qualify for free drugs and have to stop treatment. My understanding is that this is a sure fire way to create resistent strains of HIV. It also means that she will have a harder time pushing back the change over to full on AIDS. I wish that I was rich enough to have said that I would pay for her treatment... But I guess I have to be content with trying to influence policy and make sure that other girls are more careful than she.