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Girlfriend tested positive at 2 months pregnant

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negThai:
Hello all, just to share my story, I'll be looking for advice on a number of things.

I've been living in Thailand for several years and met a wonderful (Thai) girl a couple of years ago. She fell pregnant earlier this year and then the second bombshell landed. I was very aware of the prevalence of HIV in Thailand, but its not all that romantic going to get tested at the beginning of a relationship, not really the first thing on your mind......

So after hearing her news from her doctor 5 minutes after she had, I was in a mess trying to hold together for her. Went for an immediate blood test and had to wait 5 hours for the results. Went off for a nice walk where we talked about being strong together, how we still wanted the baby and how we were still going to get married. I had convinced myself that I too was positive.

My negative test came as a shock, we'd had unprotected sex for over a year and I had thought that if I had been negative going into the relationship, there was no way I was going to be negative now. But I was, I didn't understand, I skipped everything and went straight to the question 'Is the baby mine?' which obviously went down like a lead balloon. My research since has said that chances of female to male transmission are low and I was quite uneducated about this whole thing. I have my follow up test next month, research suggests I should be OK, but I'm counting no chickens yet. Condoms it is now.

We switched hospitals for a place the doctor recommended as having a specialist unit for pregnant HIV mothers. First blood test came back with a CD4 of <300, repeat a few days later at a different time of day was also <300. They declined to put her on medication as she hadn't yet completed her 1st trimester.

A week later, she developed shingles. A more senior doctor apologised and said she should have been put straight onto meds. The shingles has cleared up with medication and some local doctor magician's help, just a few scars now, and she's on meds, emotionally stronger and unwilling to switch hospitals again.

We have a few issues specific to Thailand. I've noticed a few members here with Thai connections...

Her Tabien Baan registers her at an address in the neighbouring province. The doctor we are currently dealing with has said she can receive treatment at this hospital until the baby is born, but subsequent treatment must occur at the hospital local to her Tabien Baan. Is this correct?

Secondly, the doctor said she was entitled to medication for the next 5 years free of charge. Is it only free for 5 years? Costs are generally sub 5000B a month, so we can afford it, but with a baby on the way, that 5000B will possibly mean quite a lot in 5 years time.

Not related to Thailand, her CD4 count was 290 (ish) on both tests after diagnosis. My understanding is that this means the disease is quite advanced. Several years ago, medication would, in western countries, have begun one CD4 was sub 300, but now the threshold is higher. What impact will this have on her life expectancy (she is 30 now).

Finally, the social stigma attached to HIV here is huge. My girlfriend is terrified her family will find out as she fears rejection, and so only myself and two of her (very carefully chosen) close friends know (I couldn't deal with everything on my own, I had to have her talk to friends about it as I was desperately trying to deal with my own emotions). I've made a decision not to tell my parents until I know my 3 month follow up results. I would rather not tell them until I know the baby's status but they're both coming over in the months after the birth, and both will be questioning the lack of breast feeding and my mother will be here when the baby will be taking meds in the 6 weeks after birth. Any advice on talking to family about this all?

That's all for now, I've not written about this so far, not talked about it with anyone other than my girlfriend so far and so any advice will be much appreciated.

TabooPrincess:
You mention a number of issues and sound practical in your knowledge and reasoning.  I think your main concern at this moment in time needs to be the health of your girlfriend and baby and all the other things can wait until later.  I went through my entire pregnancy without telling anyone and couldn't think of much else other than my baby being ok and praying, praying, praying for this.  Perhaps your girlfriend is thinking the same - so to add other stressors such as telling people/finances/social stigma to this equation may be counter-productive.

Stand back a little from it all and try to see the wood for the trees so to speak. 

If you don't want to tell your family then they don't need to know.  Many women don't breast-feed for many reasons and it's very easy to give the baby medication without anyone needing to know or see.  But if you do want to tell them then make sure you're not placing yourselves under more worry and stress by having to also deal with their worry and stress.

Common_ground:
Hi!
1. Find a real good doctor. In Thailand the knowledge of HIV among doctors varies a lot. This is probably the most important both for the child, your wife (to be), and you. Preferrably one who specialize in HIV, shouldnt be hard to find as there are quite a few.

2. She can move officially by registering a new adress, this would give her the right to receive treatment and care where you live right now. My advice is although to pay for her treatment out of pocket. Socially funded HIV care in Thailand is only at a bare minimum, there is for example limitations on how many Viral load and CD4 tests you can receive per year and also what kind of meds she is able to obtain. Private care is very affordable. Regular labs,doctors fee, and meds shouldnt cost more than 3000-4000 THB a month.

3. If she takes care of herself and she is not sick now she will live a looong time. Key here is, I believe, the care you are able to afford.see #2.....

4. I dont agree that HIV is more stigmatized in Thailand than in most other countries. This might be you or your partners view. Regardless of HIV, Social norms might make it hard to reach out for help and support but immediate family will probably be there but once/if she disclose, then however the family might veto her right to be open about her status to save face. If you lived in Thailand for some time you probably know these kinds of things. Afterall with about 1% of the population infected everyone "knows" someone with HIV.

Good luck, welcome to the community and dont stress out too much, it will all work out in time.

negThai:
Thanks.

The doctors she's seeing at the moment are pretty good, as long as we don't end up with the young ones (the first she saw was only 26 or so years old, seemed fresh out of university). The more experienced one has been excellent and researching her treatments gives me confidence they're doing the right things, even if they never explain anything to her....

I think we'll go private for the final trimester of the pregnancy. Same doctors, but more thorough care. Any advice on vaginal birth vs c-section? I can see negatives of vaginal, but research suggests there is no benefit of c-section with regard to infection risk.

TabooPrincess:
I had c-sec because I wasn't un-detectable at birth.  Research shows no difference if she is un-detectable and follows all other precautions.  Go for natural if you can - not being able to breastfeed takes away some of the bonding experience and also c-section did this for me.  Quicker recovery time and therefore more enjoyable first month with the newborn

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