"I should have died by now," Patti Radigan says simply as she ticks off the events of her life. One of four children born to middle-class Catholic parents on Long Island, she has worked as a waitress, a drug dealer and a prostitute. She has been addicted to heroin, cocaine, uppers, downers, alcohol and pot. Her first husband died of a heart attack minutes after making love to her. She has been beaten by dozens of men. She has given birth to one daughter, who was taken away from her, and one son, whom she put up for adoption. She has had an abortion. She has lived in the projects, in prisons, halfway houses, treatment centers and a cardboard box.
Sitting at the kitchen table in her small, boxy, San Francisco home, Patti discusses her latest incarnation as Mother. She decided to have another child, her fourth, after testing positive for HIV. She chose to have the baby even though she knew she could infect her infant with the AIDS virus. She broke, in effect, the most sacred maternal law: She put her child in danger.
Patti says she wanted to do motherhood right this time. Free, finally, from the grip of drugs and involved with a man who cared for her, Patti decided it was time.
The product of her decision, Angelica, plays noisily on the floor. The small, dark-skinned girl flashes a mischievous smile, tugs on her mother's leg from underneath the dining room table, then runs away in a fit of shrieks. Angelica appears to be a happy, healthy 18-month-old, and so far, she is. So far, Angelica has not tested positive for HIV and chances are she won't. HIV infection can usually be detected by 6 months.
Why did Patti Radigan feel like the risk was worth taking? Where does a 38-year-old former addict with HIV go if she wants to have a baby?
Radigan was referred to BAPAC, the Bay Area Perinatal Aids Center at San Francisco General Hospital, a program that provides health care for HIV-positive women and their children. A report released in April by the National Institutes of Health stated that "Women with HIV often have great difficulty accessing health care ... they often lack social support and face other challenges that may interfere with their ability to adhere to treatment regimens." But for nearly 200 women who have been cared for at BAPAC, the NIH statement rings hollow. Programs like BAPAC are an antidote to the impersonal urban clinics that are often a pregnant woman's gateway into the AIDS health-care system. The BAPAC strategy -- early drug treatment coupled with non-judgmental health care and large doses of education -- has broken new ground: Since April 1995, every woman who received prenatal care at BAPAC has given birth to a healthy baby.
This has made the San Francisco clinic a model for the rest of the nation.According to the federal government, the rate of HIV infection among infants is steadily declining, but more than 500 children were diagnosed with AIDS last year.
When asked about BAPAC's impressive track record, Maureen Shannon, a midwife and nurse practitioner at the center, raps her knuckles on a desk. "I have to knock on wood every time I talk about it," Shannon says. "I'm superstitious." The clinic's high success rate, Shannon says, results from the time and care put into each case. "When the women are about to give birth, we need to monitor them all the time -- we literally become one. We call them, they call us. All the time." But intense one-on-one care is not all BAPAC offers women with HIV. It also offers them drug therapy.
"There aren't that many places where pregnant women get access to state of the art anti-HiV drug therapies," says Karen Beckerman a perinatalogist at San Francisco General. "There is a great deal of fear concerning giving women drugs when they're pregnant because of potential birth defects or other problems."
The success of protease inhibitors -- the pharmacological cocktails that are keeping many AIDS patients alive longer -- means that women who once had trouble getting out of bed can suddenly envision themselves chasing around a toddler. Before the advent of the protease cocktails, BAPAC relied solely on AZT, beginning clinical trials of the anti-viral drug in the early 1990s. While today most women at BAPAC elect drug therapy, this was not always the case. "We've had drug users in here who had taken every drug on the street who wouldn't take AZT," says Shannon. "They remember Tuskegee [the infamous Alabama medical experiment in which black patients with syphilis were given placebos] and I have to explain that Tuskeegee was about withholding treatment."
Until a few years ago, AIDS was viewed as a largely gay male disease, and research and treatment studies reflected that. "Women have been overlooked in AIDS research," says Beckerman.The treatment of pregnant women is even more substandard, she says, and many physicians remain uneducated. "Most people, doctors included, believe transmission between a mother and her child is 100 percent," says Beckerman. "But even without treatment and prenatal care, transmission is 25 percent." Shannon says that BAPAC was getting so many calls from hospitals unaccustomed to delivering babies of HIV-positive women that BAPAC created a written birthing protocol that it now faxes to delivery rooms around the country at a moment's notice.
Along with the misinformation about transmission, says Beckerman, women with HIV must contend with a slew of prejudices -- especially women who want to have children. "There is a huge misconception that AIDS is the result of having some strong sexuality," says Beckerman. "And while it is accepted that gay men are sexual, people view women who get the virus from sex or drug use as engaging in unforgivable activities."
"Often when an HIV-positive pregnant woman goes to a traditional abortion clinic for counseling, they are advised to abort," says Shannon.
"The first thing the women who come here gauge is, 'Are you going to judge me for being pregnant?' I tell them what I know. And they make choices. It would be ludicrous to do otherwise. Why threaten them?"
It was BAPAC that helped turn Patti Radigan's life around, she says.
The pale skin on Patti's neck is scarred with a thick purple track mark; her long arms look like they have been raked with needles. Despite these artifacts of her drug days, Patti looks subdued, conservative even, in khaki Bermuda shorts and a white polo shirt. Her date book is open before her, exploding with bits of her new life -- phone numbers, prescription slips, coupons.
Patti says she could have contracted AIDS from any number of friends, lovers or clients -- but she assumes it was from one of her "regulars." She began working as a prostitute once her drug habit couldn't be supported by her waitressing tips. "Other girls robbed, I lay on my back and fucked people," Patti says. "Men would pay extra to not wear a condom ... as torn up as I was, men would still want to have unprotected sex with me. Afterwards, some of them would go home to their wives."
Before she was infected, Patti never gave AIDS a passing thought -- she didn't know women could even get it. The only reason she got tested at all was because a medical outreach project in her neighborhood was offering cash in exchange for participating in an AIDS study. "When they told me I was positive, I thought, I can't work prostitution anymore. I have no work, no money, no love, no children, no boyfriends. What am I going to do?"
A friend pointed out that maybe getting infected was a blessing -- her HIV-positive status would make her eligible for government benefits like Supplemental Social Security Income and methadone treatment. She took his advice and checked into a treatment center, where she received group and individual therapy and drug counseling. After seven months, she was clean -- but pregnant. "My boyfriend fucked me while I was asleep," she says. "He knew I was HIV-positive but he said he needed 'skin on skin.'"
Like many people, Patti thought if you were HIV-positive and had a baby, the child would automatically be infected. When she was first referred to BAPAC in 1993, Maureen Shannon told her of the risks. "I saw Maureen and she told me my options and said, 'It's your choice. We'll be with you if you have it, or if you terminate.' She was so nice and friendly. I had hope." But when Patti went to see her primary care physician at the hospital, she changed her mind. "This older male doctor came in and said, 'You're 36 and HIV positive!' He made me feel like there was no chance I would have a healthy baby. Then I went to my group therapy session and they all thought I was crazy for wanting one too. By the end of the group I felt this big" she says, holding her index finger and thumb a millimeter apart.
Patti aborted the baby. Her boyfriend, Roman, was furious. She started using drugs again. But she didn't forget Shannon. It took her several months of prostitution, heroin and beatings to wake up again. "I was so sick of being a nobody."
Six months into a second round of treatment, Patti was pregnant again and Roman proposed marriage. "I thought, I'm an HIV-positive former addict and he wants to marry me? Who else will have me?" She broke the No. 1 rule of the treatment center where she was living: She had unprotected sex.
"I wanted to prove myself. I wanted to prove that I could be a good mother, a good person. Just because I'm HIV-positive, can't I bear children?"
Dr. Beckerman admits that some of her colleagues disdain programs like BAPAC that offer HIV-positive women preconception counseling and a supportive environment. Some people believe people like Patty Radigan should not be allowed to have children.
But Beckerman feels differently. "The golden moment is when we send out an antibody test at year 1 and the baby is HIV-negative," she says. "To me it's a deeply moving moment to see the antibodies disappear."
Eighteen months after Anjelica's birth, Patti has secured them a home with welfare funds. Roman, Anjelica's father, does not live with them -- he cheated on Patti and she kicked him out -- but he visits his daughter and contributes money for diapers and other supplies. Someday Patti hopes to get paid to make speeches. About her life, about her treatments and about HIV.
"When I went back to BAPAC for the second time, Maureen remembered my name," Patti says, still astonished. "She made me believe I could have a healthy baby and that I deserved to."
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