decisionmaking.

The questions listed in Figure 7-6 are extremely helpful, but it is also important to remember that

many clients have never made reproductive decisions. Their substance abuse problems have been

at the forefront of their lives for so long that they may find it difficult, even in recovery, to "own"

their decisionmaking responsibilities. One way to provide support in this area, and help build

coping skills, is to encourage women to talk with other women--to become part of a support

group that is based on empowerment and women helping women. Counselors should see

reproductive decisionmaking as a very high priority and move toward this goal in small,

incremental steps.

At present, no one knows exactly how to predict which mothers will transmit HIV to their

infants. Although there is some speculation that a mother's viral load, measured through viral

load assays, may indicate whether her infant becomes HIV infected. Much is still unknown, and

controversies abound, but providers must understand and respect the importance of self-

determination and the right of women to make their own decisions. Ultimately, it is the woman's

choice.

Today, HIV-positive women are looking at the prospect of pregnancy differently than they did in

1989. HIV-positive women who think about becoming pregnant have access to information

about viral load testing and the possibility of artificial insemination. Also, HIV -positive women

can consider a natural rhythm method, identifying fertile days and limiting unprotected

intercourse to those times to decrease their partner's risk of HIV infection. There is no question

that even today, facing pregnancy while HIV positive, examining the options related to

terminating or continuing a pregnancy, deciding about medications, examining the woman's

health and the infant's health, and addressing the long-term implications are all complex issues.

It is essential that providers examine these issues with clients within the context of a

biopsychosocial framework. Counselors and health care providers must work together, along

with the female client, to stay aware of the latest research and information regarding HIV/AIDS

treatment. It is also important to remember that data and information on HIV/AIDS are

constantly changing and that the "facts" provided to clients today may be very different

tomorrow.

Parents who are HIV positive

More and more resources have been developed for single- and two-parent households in which

one or both parents are HIV positive and/or the children are HIV positive. There must be a

continued awareness of the needs of these families.

These families experience the need for a variety of services, both child-centered and adult-

centered. Concerns about guardianship for children after the parent is unable or unavailable to

care for them must be a major focus for the parent and the service provider. Unfortunately, many

clients who have long histories of substance abuse may have "burned many bridges," and the

family support they need for permanency planning and establishing an appropriate guardian for

their children is no longer available. All too often, there is only a tired, abused, and used