CAGUAS, Puerto Rico _ Before the virus overwhelmed Puerto Rico, Zika already lurked in Keishla Mojica's home.
First her partner, John Rodriguez, 23, became infected. His face swelled and a red, itchy rash covered his body. Doctors at the time diagnosed it as an allergy.
Two months later, Mojica, 23, had the same symptoms. Medics administered shots of Benadryl to soothe the rash and inflammation. She didn't give it much more thought.
A month later she found out she was pregnant, and that eventually led to a surprising revelation. The rashes hadn't been caused by allergies, but instead by Zika, a virus known to cause serious birth defects.
Since 2015, the virus, which is spread by mosquitoes and sexual contact, has risen from relative obscurity to a worldwide menace. Puerto Rico marks the epicenter of the outbreak in the United States. As of Dec. 16, the commonwealth's health department reported 35,648 confirmed cases, including 2,864 pregnant women. Federal health officials have declared a public health emergency here and anticipate 25 percent of the population will have contracted the virus by the end of 2016.
The epidemic raises difficult personal questions for women like Mojica, who live on an island with strong religious undercurrents and a health care infrastructure bowing under the weight of fiscal debt. Is abortion acceptable or can faith overcome the fear? If a baby is born with disabilities like microcephaly, characterized by an abnormally small head, or cognitive impairments, how will families provide the care a child will need?
In response to the association between congenital defects and the virus, virtually all pregnant women on the island undergo testing for Zika as part of their prenatal care. Dr. Alfonso Serrano, 57, chairman of the obstetrics and gynecology department at HIMA San Pablo Hospital in Caguas and Mojica's doctor, said the testing has shown that 5 to 8 percent of his patients contracted Zika.
Even though the threat of Zika frightens women, he said, most of his patients don't consider abortion.
"It's not something that is talked about every day," he added.
Serrano attributes the aversion to terminating a pregnancy as more of a cultural idiosyncrasy than particularly devout faith. Abortion is easy to obtain here and relatively inexpensive, but surveys show that an overwhelming majority of residents said they oppose the practice.
For Mojica, abortion was the first thought that crossed her mind when she heard she had been infected. She told no one but her mother and Rodriguez about the diagnosis. She cried and prayed often. Public service announcements on television about the outbreak angered her. But Mojica never actually discussed the possibility of an abortion with anyone, and she realized quickly that she couldn't choose that option.
"I waited until they gave me the results and that they verified everything," she said. But Mojica added that she quickly put aside any thoughts about abortion. "I said, 'No, forget it. Everything's fine. Forget about it.' That was in the moment."
