#9: HIV and the First 72 Hours

Case Notes #1: 31F HIV+ patient and her newborn baby

Life is moving sweetly—but sometimes it moves fast enough to force hard decisions.

We have been treating a 31-year-old woman who gave birth by caesarean section at 3:00am on January 26th. When we tested her blood later that morning, we discovered that she is HIV positive. When we shared this result with her, she told us she already knew. But she also told us something else—that her husband doesn’t know, that no one in her family knows, and that she was not planning on telling them.

At least for me, this was one of those moments I was referring to in the last post where the plot truly thickens.

Our immediate concern shifted to the baby. The newborn needed prophylactic HIV medication as soon as possible, ideally within the first three days of life, and the sooner the better. The medication, Nevirapine, can significantly reduce the risk of transmission if given early. But Albertine Hospital does not stock HIV medications. In Uganda, HIV/AIDS treatment is provided free of charge by the government, which means these drugs are distributed through governmental clinics rather than private hospitals like ours.

The nearest clinic is actually very close to us—just a short walk away. Despite limited resources, many of their most severe patients are transferred to us because we have an operating room, a NICU, a more robust emergency department, and an X-ray machine. I am still learning the dynamics of healthcare systems in this region, but I know this much: Albertine Hospital is the best-equipped building for miles.

The complexity of the situation continued. The mother told us that she had already picked up the medication secretly and that it was at her home. She said she would give it to the baby herself. But the baby needed the medication immediately, and every hour that passed mattered. And, it is impossible to pick up the medication before giving birth. We asked the clinic staff…so she was lying. This means she would rather let her baby be HIV positive than tell the truth :( She has been lying about several things since she arrived, in fact…

On the morning of January 27th, Prudence, one of the nurses, and I walked to the government clinic to look for Nevirapine. The medications available to the morning nurses were expired, so we were told to return later once the storage area could be checked. Every delay felt heavy. Every hour was another hour that the baby remained unprotected.

I planned to go back around noon—but then Hillary stopped me.

He believed strongly that it needed to be the mother, or a family member, who obtained the medication. HIV treatment, he explained, is not just a one-time intervention. It is a long-term commitment that requires follow-up, adherence, and honesty. The baby would need additional medications in the coming weeks. His concern was that if we fetched the drug ourselves, the mother might disengage from the broader treatment plan. He also believed that the husband had a right to know, and that by intervening for her, we would be avoiding a difficult, but necessary truth.

I understood his reasoning, but I disagreed. So did several other members of the hospital staff.

We agreed that honesty mattered. We agreed that disclosure was important. But we also believed that withholding a time-sensitive medication from a newborn—when it was only minutes away—was doing a disservice to a patient who had no agency in the situation. We felt that we could both encourage the mother toward honesty and protect the baby.

I’m not entirely sure how Hillary was convinced, but about thirty minutes later, he came back to me and told me to go get the medication.

I was so relieved.

I walked to the government clinic myself, obtained the Nevirapine, and we administered it at 1300 hours. The sense of relief I felt afterward was overwhelming. The situation is still sad, still complicated, still unfinished—but in that moment, it felt good to know that Albertine Hospital had helped in a tangible, meaningful way. 

Life is moving sweetly, but it doesn’t always move simply. Sometimes it moves through disagreement, urgency, and ethical uncertainty. Sometimes the best outcome isn’t perfect—it’s just better than what could have been.

And sometimes, helping means acting, even when the answers aren’t clear.

If anyone has any better solutions, I am all ears….