Testing and counseling women who are HIV-positive would give them the knowledge to make decisions about whether and how to give birth, helping them understand how to lower the odds that their babies might also become positive. Unfortunately, testing is very expensive, and medical personnel generally test only women who exhibit symptoms of HIV infection, when and if they seek treatment at clinics. Counseling programs are rare in Tanzania and much of sub-Saharan Africa, particularly in rural areas. Some nongovernmental organizations and medical facilities offer maternal counseling, but it is not widespread enough to serve all the women who need it. Structural problems also limit action that HIV-positive women can take, once they know their status and are aware of the risks of maternal transmission.
Abortion is illegal in Tanzania and many other African countries.
Women who choose to terminate their pregnancies must either have enough money to go discreetly to private doctors or be able to convince a doctor to rule the procedure medically necessary in order to get a free or inexpensive abortion at a public clinic. Contraception to avoid further pregnancies can be difficult to get and sometimes prohibitively expensive for poor women. Dealing with Denial But even for women who have access to testing and counseling, knowledge is not always power. Financial dependence on men and traditional gender roles may deprive HIV-positive women of the ability to make decisions about childbearing and health. Christine is a mother of three who lives on the outskirts of Dar es Salaam.