Suspicions of Abuse

Maria P. is a 25-year-old woman who made an initial visit to the clinic for prenatal care when she was 18 weeks pregnant. She has returned for a second prenatal visit at 22 weeks of gestation. Maria has a 4-year-old son and a 2-year-old daughter. Her record indicates she had several bruises, lacerations, and a black eye during her last pregnancy that she attributed to clumsiness. Her 2-year-old weighed 4 pounds, 8 ounces at birth and was 17 inches long. As part of routine prenatal care for the most recent pregnancy, Maria was tested for HIV antibodies. The test was positive, and the physician and nurse conveyed this information to Maria during her second prenatal visit. Maria, of course, was quite upset. She admits that her spouse has been physically abusing her for some time and that both have used intravenous drugs in the past. She has had no sexual partners other than her spouse. The nurse encourages Maria to tell her spouse that she is HIV positive so that he can be tested for antibodies. She also encourages use of condoms during sexual intercourse to help avoid transmission to her spouse should he not be infected. Maria insists that her husband refuses to use condoms as they interfere with his pleasure. In addition, she says he would kill her if he knew she was HIV positive. The nurse encourages Maria to go to a shelter for abused women and links her to both a counselor and a social worker who help her devise a safety plan. However, Maria ultimately decides to go home because she cannot abandon her children, and she does not want them in a shelter. She knows she cannot make it on her own, as she has neither income nor job skills. She requests that the clinic not interfere and that the clinic workers allow her to decide if, when, and how she will notify her spouse about her HIV status.