[Women and HIV/AIDS: stormy beginnings]

Following the transfusion of a young woman with two units of blood infected by human immunodeficiency virus (HIV) during a Cesarean section performed at the Obstetrics and Gynecology Unit of Port-Royal Hospital in Paris in 1984, the author realized the danger that this virus would represent for women and their children, at a time when the infection seemed to be confined to homosexuals, drug addicts, hemophiliacs and transfusion recipients. He was confronted with a whole series of issues, including the rejection of HIV-positive women; the need for special precautions in the labor room and operating theater; and the need for these patients to be managed in a single center staffed by skilled and willing healthcare professionals who could help them decide whether or not to continue the pregnancy. The main risks at this time were the onset of life-threatening opportunistic infections during pregnancy and HIV transmission to the child (estimated at 20% to 30%). Other thorny issues included the case of couples wishing to have children when either of the two members was infected, and the question of professional confidentiality when an immunocompromised HIV-seropositive husband stubbornly refused to inform his wife or to use condoms. It seemed important to bring these women together, especially those of African origin, within a self-help group where they could express themselves openly and discuss their difficulties. Screening for HIV antibodies in early pregnancy became necessary to permit preventive treatment of mother-child HIV transmission, and to inform pediatricians. There was also a need to estimate and monitor the seroprevalence of HIV among pregnant women, and this was done by conducting a "sentinel" survey that was subsequently taken over by INSERM and the European Centre for the Epidemiological Monitoring of AIDS. After listing many other issues that were hotly debated over the years, the author describes how, at the beginning of the epidemic, new proposals intended to systematically improve the lives of these women and their children ran into official procrastination, due to the combined pressure of short-sighted doctors, homosexual groups, and a cohort of sociologists and philosophers posing as apostles of human rights and omnipresent in the media.