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Ashley Nutt

Junior, biomedical sciences
College of Sciences and Mathematics

While many college students spend their summers relaxing from the stress of a heavy course load, Ashley Nutt, a junior in biomedical sciences who maintains a 4.0 GPA, seized the opportunity of three months of freedom to immerse herself in her chosen career path. This Atlanta, Ga., native worked in Jamaica last summer as part of an international research program sponsored in part by the National Institutes of Health. While in Jamaica, she researched the epidemiology of repeat pregnancy among HIV positive women. Nutt said she hopes to one day become a physician, and she is leaning toward a career in rural and international medicine. The experience of working in Jamaica helped solidify her career goals.

1. What was it about this international research program that appealed to you?

Microbiology has always been my strong suit, so to look at a disease like HIV from an epidemiology perspective was really intriguing. Risky reproductive behavior was a major factor in repeat pregnancy in HIV positive women. Many of the women surveyed have low self-esteem and travel from relationship to relationship. At least 46 percent of the women surveyed had at least one unplanned pregnancy. There are currently around 15,000 children with HIV, and most of them contracted the virus through the mother. Pediatric immune systems are more sensitive to HIV; children do not process the disease the same way and there is a higher mortality rate.

2. Why are repeat pregnancies so common amongst HIV positive women in Jamaica?

HIV positive women often experience repeat pregnancies because of a lack of knowledge. Many women have no idea what a virus is, or what white blood cells are and why they should be concerned about their white blood cell count. Many are unaware of the reasons they have to take medication every day, and some are not fully aware of how HIV could spread from mother to child through vertical transmission. Health care in Jamaica is paid for by taxes and is free and available to anyone. So, the knowledge is available. They have social workers who remain with HIV positive women from the time of diagnosis onward, regardless of whether she becomes pregnant or not. The social workers will continue to test the children of HIV positive mothers until they are 1 year old. If the child is positive, they attend pediatric clinics. The social workers also work with the women and encourage them and teach them about HIV, but 51 percent of the women we surveyed were unemployed. As a result, the women with a low socioeconomic status are mostly concerned with basic needs like food, water and shelter, not HIV and pregnancy.

3. It sounds like HIV is a serious problem in Jamaica. Based on your experience, why do you think that is the case?

Twenty-seven percent of the women we surveyed did not disclose to their partners that they are HIV positive prior to engaging in sexual intercourse. These women remain silent about the disease because they fear their partner's reaction. They also fear being ostracized by society, fired from jobs or abandoned by family and friends. In Jamaica, 1.7 percent of the population is HIV positive, which is higher than the U.S., Canada and Mexico, combined. The virus keeps spreading due to lack of disclosure. Of the HIV positive women we interviewed who had repeat pregnancies, some were unplanned, but many were actually planned. Nine percent of women with planned pregnancies felt compelled by their partners to continue conceiving and did not resist for fear of discovery. Some of the HIV positive women who had repeat pregnancies felt that since they had experienced previous positive health outcomes, it was not a big deal to get pregnant again.

If a pregnant mother is vigilant about taking her medication, she can prevent passing HIV to her child. However, many barriers prevent pregnant mothers from taking the necessary medication. A trip to the pharmacy can take all day. If you do not want to tell your employer that you are HIV positive, how do you get off work to go to the pharmacy when you risk getting fired if your employer finds out why you are going? There are clinics in the rural parishes where you can pick up your medication and talk to a social worker, but the poverty level is so high outside developed areas, that women do not have the money it takes to get to the clinic. Taxis are inexpensive, ranging from $1 to $3 per trip, but it would take these women a month to save that kind of money. And, what do you do with the children while you are at the hospital? These women can get the medication they need, but they have extreme difficulty. A lot of social workers make home visits because the women can't get to them.

4. What was the biggest lesson you learned from your experience?

In Jamaica, unemployment is high, cheating and infidelity are common and the population is difficult to motivate. When looking at something like a disease, I know now that I can't just look at it from a pharmacological perspective. If you can't get people to quit spreading something, how are you ever going to cure it? But the health care system and the Ministry of Health are really trying to get information out there to the people, and they are. A lot of awareness efforts are under way. There are just so many factors that come into play with HIV and pregnancy; it is difficult to get to the root of the problem. It is not like reading a textbook where you learn about HIV and the drugs you take for prevention and the answers are cut and dry. I was dealing with real people, so it might take years to see if education efforts actually work. There is not one cause and one fix for something like this. The solution has to be collaborative among doctors, social workers, government and people. You have to understand where one another are coming from and really get both sides of the story to work together to find some kind of solution.

5. Did the experience of working in Jamaica last summer change you?

Yes. I am still processing my feelings, even months after the experience. I feel like I have made lifelong friendships – the people were so inviting and so warm and caring toward us. The experience gave me a chance to study abroad and see health care outside of the U.S., and it gave me a great appreciation for my life and the opportunities I have had. I do not take hot water and air conditioning for granted anymore! I am more appreciative of everything I have. I also think it solidified my desire to work in rural medicine and international medicine. I really enjoyed my experience there and watching the difference these doctors and health care workers make in these women's lives - I felt like, I want to be a part of that one day.

Apr. 8, 2013