TORONTO - It was the ill-advised actions of one nurse that pushed midwife Jay MacGillivray to put her foot down.
On-call and frequently on the move, MacGillivray found herself in a major Toronto hospital one day in 2005, wiping tears from a pregnant woman terrified she was going to lose her baby.
The woman - who was HIV-positive - was sick, and frightened it was a result of her condition. But MacGillivray, an experienced midwife since the '80s with experience working with HIV-positive people, knew the woman's fears were unfounded.
As she clasped the woman's hand, a nurse sidled up to the pair, palming an alcohol hand sanitizer pump. Looking down at the woman, she nudged MacGillivray: "Don't touch her."
The encounter prompted MacGillivray to rush to get aid from a respected colleague, Dr. Mark Yudin.
"I marched into his office, dropped my fists down on his table, looked him in the eye and said, 'You and I have to work together, because this is just stupid,"' she recalled.
It was under those circumstances that the Positive Pregnancy Programme was born, a made-in-Canada approach to caring for HIV-positive women. Pairing the wraparound model of midwifery with practitioners well versed in HIV, the program has already garnered international attention - yet remains under the radar at home.
Thanks to remarkable advances in medicine, HIV no longer inevitably leads to AIDS or a death sentence. In Canada, it's a manageable condition in which people can live healthy, satisfying lives.
While lack of treatment for an HIV-positive woman equates to an up to 30-per-cent risk she will transmit the virus to her baby, the correct medication and care drops that risk to less than one per cent. It also means there is little to no need for a caesarean section birth.
Yet stigma and misinformation - like the false belief that the virus abounds in tears - endure, MacGillivray said, sometimes even in the hallways of health-care institutions.
"There are people who are up to speed and compassionate and wonderful and clinically terrific who are nurses, but not everybody is comfortable with HIV," she said.
"I once had a nurse say to me, if I ever found out that somebody had knowingly got pregnant while HIV-positive, I would call Children's Aid."
Some 150 to 175 babies are born annually in Canada to HIV-positive mothers, according to the Canadian Pediatric AIDS Research Group.
Extreme fear about how they'll be treated is likely driving a number of these women to have unsafe, unattended home births, MacGillivray said.
It's something she's determined to stop.
Together, she and Yudin - an obstetrician and gynecologist with extra training in reproductive infectious diseases - care for the pregnant women from pregnancy, through labour and beyond.
They see to it the expectant mother is attended by clinicians and specialists comfortable and accustomed to working with HIV-positive people, rather than shuffling her from doctor to doctor.
"It's a little unusual for a midwife and obstetrician to work so closely together," Yudin said. "To me, this is a bit of a unique entity where we can really offer something special to these women."
MacGillivray, who practises with the Sages-Femmes Rouge Valley midwives, also hooks the woman up with the proper hospital workers to follow the child's health, a pediatrician, and AIDS Service Organizations which offer everything from financial resources to other supports.
"I become the string that draws it all together," MacGillivray said, adding that she stands between the woman and ignorance that exists.
"I will see her prenatally, try and normalize her pregnancy for her - because she's thrilled to be pregnant, but she's going to find people all the way through who, if they knew she was positive, would be horrified."
MacGillivray became an unexpected "miracle" for an HIV-positive Toronto woman who gave birth to a boy earlier this year.
The woman was dreading the treatment she'd receive when she was rushed to hospital in labour. But in the delivery room, everything changed.
"Here's someone who knows I'm HIV-positive, she's holding my hand, she is showing compassion and not judging me," said the woman, 34, who asked her name be kept private.
"It made me feel 'OK, there is somebody here who really cares about me."'
It's that holistic approach - the way the program ensures the health of both the baby and the mother is in good shape - that makes it stand out, said Lena Soje.
"(The women are) with her because they trust her," said the support co-ordinator with the Black Coalition for AIDS Prevention.
"She treats them with the utmost respect and dignity."
Yudin, who is conducting research into physicians' attitudes of HIV-positive people having children, said more than three-quarters of the women he sees have immigrated from Africa.
"A lot of them are middle class or better, are working, have a stable relationship, have a stable job," he said. "I think the general public might not get that."
He hopes one day there will be better access to safe methods for HIV-positive people to have children, such as through specialized fertility clinics.
"These are people that deserve to have a baby, just like anyone else," he said.
The pair doesn't get any special funding for the program, the likes of which they haven't seen elsewhere in Canada. MacGillivray remains frustrated by the lag in some health providers' understanding of HIV, especially when she's getting requests for help to launch similar initiatives in places like Cameroon, Botswana, Scotland, Paris and London, England.
"Our hope is that eventually we can use it as a transferable model," she said.
"That we can boost enough reality and enough clinical competence in enough places that we can use it as a template elsewhere."
