Many HIV-positive women who have babies are unaware of their HIV status. In 2002, 30.1% of the 5.5 million pregnant women in the United States were not tested for HIV. Even when pregnant women learn that they are HIV positive, they often decide to continue the pregnancy despite the risk of passing the infection to their babies. Some women choose to become pregnant already knowing that they are infected with HIV. Many people consider HIV-positive women who decide to have babies to be selfish and unconcerned with the potentially tragic consequences of their actions. Still others regard the decision as strictly personal and understandable. The choice an HIV-positive woman makes to give birth can reflect an optimism that is fostered by effective drug therapies and a new reality--that many people with HIV infection are living longer, more comfortably, and asymptomatically.

The choice to bear children also reflects societal and environmental realities, as well as attitudes about death and illness. Most women with HIV/AIDS live in poverty; they do not have easy access to medical care, and socioeconomic problems such as violence, homelessness, separated families, and low literacy rates challenge children's chances of leading long, safe, and healthy lives. Felicia R. Lee reports in ''Anguish in Era of AIDS: Choosing to Have Babies'' (New York Times, May 9, 1995) that Tracie M. Gardner, an AIDS policy analyst for the Federation of Protestant Welfare Agencies, believes that for many women in poor communities HIV infection is the least of their problems. Gardner recounts the story of a pregnant inner-city woman in her early twenties who, when told she was HIV infected and had ten years to live, replied that this was nine more years than she thought she had.

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