At 20 months of age, Yordanny Zier could not know that her mother was a crackhead, a woman who says she spent much of 12 years in Las Vegas whoring for a fix.
And Yordanny could not know that her mother exposed her to HIV, the virus that causes AIDS.
She lies in her crib, a dark-haired beauty drooling on her pretty blue outfit. Her eyes never leave her mother. She makes no effort to get up, does not cry or whimper or giggle or smile as a visitor enters the room.
Quiet. She is so quiet.
Adriana Zier, who said she's been off illegal drugs for two years now, picks up Yordanny, pointing out that doctors tell her that she is about five inches shorter and nine pounds lighter than other children her age.
"It's not my daughter's fault or any other kid's fault when they're brought into this world by parents who are screwed up," the 41-year-old Zier said as she sat in a living room of a small apartment off Maryland Parkway and Karen Avenue. "I can't imagine how a program that can give innocent children a chance at a normal life can be killed.
"I know many people hate those of us with HIV, but don't take it out on babies."
Zier said the medical treatment she and her daughter have received at the University of Nevada School of Medicine's Nevada Care Program has given her hope that her daughter won't develop HIV.
But the program, which largely works to prevent mother-to-child HIV transmission through targeted antiviral drug therapy, has been eliminated by the state Department of Health and Human Services. Citing a possible $1.2 million shortfall in funding for HIV/AIDS related programs next year, state officials terminated the $350,000-a-year program as of today because of a projected increase in both medication costs and clients utilizing services.
The program was the most severely affected by cuts directed to six HIV/AIDS programs in Southern Nevada.
When the program began in 2006, there were four cases of infants with HIV in Clark County. Since the program's services began, however, there have been no new cases identified, although 40 infants have been born to HIV-infected mothers.
Dr. David Gremse, head of the School of Medicine's pediatric program, said under guidelines set by the federal Centers for Disease Control and Prevention, no determination is made of whether a child is positive or negative for HIV until the age of 24 months. So doctors won't make a finding on Yordanny for four more months.
Zier was in the county jail in July 2007 on a drug charge -- she said she has been incarcerated more than 60 times for either drugs or prostitution -- when she learned she had HIV. Less than two months later, she gave birth at University Medical Center.
"I am so lucky that Yordanny and I got AZT (an antiviral drug) right away," she said.
According to Dr. Echezona Ezeanolue, the director of the Nevada Care Program, the best care for an HIV expectant mother and her newborn involves three uses of the drug AZT, which often prevents HIV transmission to an infant.
Ideally, he said, the mother receives AZT during pregnancy, then AZT alone during a Cesarean section delivery.
Vaginal fluids can increase the chance of HIV transmission.
The newborn then receives AZT for six weeks along with a strong antibiotic. That antibiotic, bactrim, is continued until the baby is four months old.
"Yordanny's mother only got the AZT during delivery because we didn't see her during her pregnancy, but that is much better than her not getting it at all," Ezeanolue said. "And then Yordanny got the AZT and bactrim."
In a recent letter to Rep. Shelley Berkley, D-Nev., in which he asks for help in finding funding to continue the program, Gremse said killing Nevada Care doesn't make financial sense.
"The prevention of potential transmission of HIV infection to these 40 infants who were born to HIV-positive mothers through the Nevada Care Program's efforts resulted in the program saving the state $12,124,000 over the past two years based on the cost of providing medical care to these children had they become infected," the letter states.
Berkley said Friday she was "hopeful that the financial resources will be found to keep this important program in place."
Ezeanolue isn't shy about saying what he thinks the program's death will do.
"For unborn children especially, this is a life-and-death decision that will have consequences far greater than the state has obviously considered," he said. "These children, who would otherwise have a 98 percent chance to be born without the HIV virus, will more likely be born with the virus."
Gremse said Ezeanolue helped ensure the success of the program by reaching out to medical officials in the Las Vegas Valley and having them refer HIV-infected expectant mothers to him.
Ezeanolue said that although drugs for an antiviral program for expectant mothers and their children will still be available after the budget cut, the office space where he treats them near University Medical Center won't be. Nor will his four medical assistants.
"The bulk of the grant money goes to the space," he said, adding that women wanted privacy because of their situations.
Gremse said that Ezeanolue's team of assistants has also been critical to the program's success. He said they contact Las Vegas hospitals regularly to ensure that the mothers get proper treatment.
"With those being let go, it will be difficult to ensure that other hospitals handle these cases in the right way. In the past these cases fell through the cracks," he said.
Zier said "Dr. Eze's" caring attitude "has made me feel better about the future," and that she is doing all she can now to be a good mother. She only goes out of her apartment, paid for through funds supplied by the Aid For AIDS of Nevada agency, when either she or her daughter has to visit the doctor.
"I'm afraid drug dealers might want to come after me for ripping them off," she said.
She has a teenage child who lives with grandparents.
"I adopted my 5-year-old out," she said. "I want to give them as good a life as possible. I'm only getting $300 a month from welfare and a little over $200 a month in food stamps."
She said that after she learned she had HIV, she underwent a tubal ligation that ensured she could not have any more children.
Often, she said, she must deal with the dizziness, nausea and diarrhea -- side effects of the drugs fighting off HIV, which is usually acquired through unprotected sex or sharing of needles.
But that doesn't bother her as much as knowing that her daughter could develop HIV.
"I pray that doesn't happen," she said. "I hope what Dr. Eze has done is enough. I know he's done all he can."
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