BABY, TAKE A CHANCE ON ME
Independent (UK) 25 Feb. 2000
After discovering she was HIV positive, Gill Hickman not only decided to have a baby, but declined to take any anti-viral drugs. It was the start of a long, lonely journey.
Malachai is understandably proud of his new laptop. The six-year-old's computer is, in fact, a ring binder which, once opened, reveals a keyboard drawn in crayon. He then produces a Millennium bug made out of an egg-box. These are just the start of a string of creations he proudly brings to show me.
Sitting with him is his mother Gill Hickman, 44, who helped him make them. The love the former head teacher has for her only child is palpable. The kitchen walls in her London home are covered in photographs of him. She called him Malachai because it means "Little Angel".
Ms Hickman decided to have a child despite knowing she is HIV positive. But what will be even more difficult for many to comprehend is how this intelligent and devoted mother declined to take an anti-viral drug during pregnancy to reduce the risk of passing on the infection to her unborn child.
In the UK, 612 children are known to have been infected with HIV by their mothers, 155 of whom are reported to have died. Drug therapy has been shown to reduce transmission by about two thirds.
''People will say this is blind optimism, but I just had this faith in my body's ability to nurture a baby and not pass on this virus,'' says the mother, who is fed up with people commenting on how well she looks.
Ms Hickman discovered she was HIV positive in 1989. She decided to be tested after contracting a serious viral infection following unprotected sex. Just 33, she was head teacher of a London nursery school.
''It's the worst thing that anyone can ever tell you. As far as I was concerned my life was over. The pits lasted about three months. On the journey to and from work I just thought: 'I'm going to die, I'm going to die, I'm going to die'. I thought about suicide a couple of times. I only told my sister. In society then HIV was shrouded in secrecy, shame and guilt. I thought I would lose my job.''
The infection was a result of a casual affair which lasted two years. The man, who had always denied being HIV positive, died in September 1990. Ms Hickman married two years later. ''I told my husband I was HIV positive when I met him, but he always held it against me, particularly when he was drunk,'' she says.
Despite the problems in their marriage, after 18 months the couple decided to have a baby. ''I was 38, and loved children very, very much. The hospital said I had a one in seven chance of having an HIV- positive baby. Some people think that those odds are extremely worrying, but for me it was brilliant. I thought: 'Great. It'll be OK.' I'm naturally optimistic.
''Ultimately it's my reproductive right to have a child if I so wish to, whatever the state of my body and whatever I might pass on to it. I have been called selfish, but I just really, really wanted a baby. I had lived for five years with the virus and I was having a great life - it was actually getting better because of the realisations I had made through facing my mortality. There are a lot more irresponsible mothers out there - young girls looking for love who don't use a condom and end up pregnant and not able to support the baby.''
As the couple practised safer sex, Ms Hickman used a turkey baster to facilitate conception. She became pregnant within three months. Doctors, who were supportive of her decision to have a child, offered her AZT, a common anti-viral drug. But she refused to take it. ''I'm someone who won't even take an aspirin for a headache - I would rather let it run its course. I believe strongly in complementary medicines to support my health and am a bit suspicious of drugs and what their side-effects are.
"Also, I lived through the period when the Thalidomide babies were born, and I just didn't want to put my baby at risk of anything. I felt that in some way it could affect the development of my baby, and that maybe it would look fine, but there would be something that you couldn't see that would show up later.''
Nor did Ms Hickman opt for a Caesarean section, which is known to significantly reduce transmission of the virus. ''At the time, from the studies I was shown, I didn't feel the risk was significant enough to do that. My ex-husband and I had split up when I was five months pregnant, and I didn't want a major operation and have to look after a tiny baby on my own while recovering from it. And I wanted a natural birth - my one chance in this life to have a baby.''
She did, however, decide to bottle-feed. Breastfeeding has been found to double the rate of transmission in the absence of other interventions. (Women who opt for all three interventions - anti-HIV drugs, delivery by Caesarean section and bottle-feeding - run a less than five per cent risk of transmitting the virus to their child.)
Ms Hickman's optimism was well-founded. Tests have shown Malachai is HIV negative, and his health now, according to his mother, is ''excellent''.
Ms Hickman is not the only HIV-positive mother to question drug treatment. Last year an HIV-positive mother and her husband fled the country when a court ordered that their four-month-old daughter be tested for HIV against their wishes. Camden Council in north London had applied to the court under the 1989 Children Act for an order to test the girl, believing that if positive, she had a right to treatment. After researching the virus, the 33-year-old mother, who was breastfeeding her child, had become convinced that scientists were wrong in believing that HIV was the sole cause of AIDS. She had never taken any medication and claimed to be in perfect health.
While recognising the parents' devotion to their child, the judge said they clung to their theories ''withthe intensity of the shipwrecked mariner who clings to the plank of wood''. He did not, however, order her to stop breastfeeding.
A report by French doctors published in The Lancet last September found that in a study of 1,754 children who had been exposed to anti-HIV drugs being taken by their mothers, eight had developmental abnormalities, which led to the death of two. None of the eight children was HIV positive. However, the report stressed that further research was needed to prove a link with the drugs.
Consultant ophthalmologist Rosalind Harrison, who previously specialised in tropical medicine and has contributed to three books about AIDS in Africa, believes the French study is further proof of problems associated with drug-therapy for pregnant HIV-positive women. ''These children have suffered brain damage and have fits. Some have abnormal functioning of the retina, and it is not yet known how this will affect their vision. So far only a small number of cases have been reported, but it may take many years before we know how many more children will be affected.''
Dr Angus Nicoll, head of the HIV and STD Division of the Public Health Laboratory Service in London, believes the French report is not cause for concern. ''There are risks associated with every drug, and these are powerful medications. However, if there are serious side-effects they are very rare. At the end of the day the choice for any mother whether to take medication for the sake of her unborn child has finally to be her decision. ''