A 28 year-old woman in India, in labor outside of Hyderabad in the town of Suryapet, birthed in the street on Sunday evening covered by saris, with only the assistance of the woman who brought her to a hospital initially along with some local women who stepped up to help.

The young woman, who is HIV positive, arrived at a government-run hospital in Andhra Pradesh’s Nalgonda district in labor. Piecing together the story, it seems Alivelu’s blood was tested at the hospital. When hospital workers discovered she was HIV positive, they told her that doctors were “unavailable” to assist her and shifted her to what’s called an Observation Room.

The medical staff’s behavior apparently scared Alivelu, coupled with the fact that she was not receiving adequate care and not wanting her village to find out she was HIV positive (for fear of being stigmatized), she left the hospital. At this point, some of her relatives attempted to have her admitted into a private hospital but did not have the money to do so. After experiencing labor pains, Alivelu had no choice but to lie down on the sidewalk and birth with the help of local farm and construction workers – women who came to her aid.

According to various sources, the women who helped bring Alivelu’s baby girl into the world would likely have had numerous cuts on their hands, from the physical labor, and without any rubber gloves or protection of any kind as they assisted in the birth, there is the risk of HIV contraction from Alivelu.

In addition, of course, there is the risk to the newborn baby of contracting HIV from her mother. If born in the hospital, the baby would have had immediate access to nevirapine, a medication given to babies born from HIV positive mothers to reduce the chance of the baby contracting HIV.

Finally, and something I haven’t seen taken up elsewhere about this story, there is the very important issue of breastfeeding for HIV positive mothers. What sort of advice could Aliveru have received, that she didn’t, had she birthed in a hospital? The evidence overwhelmingly shows that breastfeeding a newborn, when HIV positive, increases the chance that the baby will contract HIV from the mother. In the United States the directive to new mothers who are HIV positive is clear: the risk of mother-to-child HIV transmission is too high weighed against the relative benefits of breastmilk for newborns.

However, the issue is much murkier for women in developing countries. In developing countries, when access to infant food (formula) is unreliable and the formula potentially unsafe, when a mother’s access to HIV/AIDS treatment is virtually non-existent or undependable, the guidelines for HIV positive mothers breastfeeding their babies are more complex. According to Avert, the international AIDS organization,

“In countries with fewer resources, where replacement feeding can be much more hazardous, the recommendations for infant feeding usually depend on a mother’s individual situation…”

“When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected mothers is recommended. Otherwise, exclusive breastfeeding is recommended during the first months of life.” 

So, while the decision depends on a mother’s individual circumstance, the WHO also says that the final decision should reside wtih the mother:

“All HIV-infected mothers should receive counselling, which includes provision of general information about the risks and benefits of various infant feeding options, and specific guidance in selecting the option most likely to be suitable for their situation. Whatever a mother decides, she should be supported in her choice.” 

The Andhra Pradesh State Aids Control Society director, R. V. Chandravadan has ordered an investigation into this young mother’s nightmare and suspended the two duty doctors saying, “There was no reason for a government hospital to deny admission to any HIV-infected person. So action will definitely be taken against those found guilty.”

Alivelu and her baby girl returned to her village but are now staying at a community health center for people living with HIV.