By Irene Nabusoba
While an HIV vaccine remains elusive, the world has found hope in one remarkable milestone: Our ability to prevent an HIV positive pregnant woman from passing on the virus to her baby. Yes, we can eliminate HIV and AIDS in one entire segment of the population: infants and the newly born.
However, although we’ve had the power to prevent mother-to-child transmission of HIV (PMTCT) through the use of antiretroviral drugs administered to HIV positive pregnant women, and exposed infants immediately after birth, stigma is holding us back.
Since its inception in 2000, the national PMTCT programme has steadily scaled up services to cover over 2,000 (40%) of the estimated 5,000 health facilities in the country.
Whereas HIV positive mothers are expected to make good use of these services to protect their babies from infection, many are shunning them for fear of revealing their serostatus.
Ministry of Health (MoH) statistics show that as of June 2012, only 68% pregnant women that tested HIV positive received anti-retroviral treatment (ARVs) for PMTCT and only 38% of their babies received ARVs prophylaxis after birth.
The World Health Organization says that without diagnosis and treatment, about 35% of HIV-infected pregnant women will transmit HIV to their infants and over half of these children will die before the age of two.
Yet with PMTCT services, pediatric HIV can be reduced to less than 5%. In fact, as if to attest to this fact, MoH statistics show that only 4% of children who received the full cascade of PMTCT interventions got infected with HIV, compared to 12% who received only partial treatment, while a staggering 35% who did not receive any of these services got infected.
How absurd! Why? This is partly due to stigma among HIV positive mothers.
The USAID-funded Strengthening TB and AIDS Response project, implemented by the Elizabeth Glaser Pediatric AIDS Foundation recently organised a regional pediatric HIV and Early Infant Diagnosis (EID) stakeholders’ meeting in Mbarara district. Doctors narrated how mothers avoid the services by:
- Giving wrong addresses and phone numbers to avoid being followed up;
- Rubbing codes off their health cards that enable health workers to identify HIV exposed infants for appropriate diagnosis and care;
- Feigning loss of health cards and presenting under pseudo names when returning for postnatal care or returning babies for immunization;
- Sending relatives and friends to return children for immunization;
- Continuing breastfeeding even when advised against it.
Well, to counter the ‘creativity’ HIV positive mothers are exhibiting in the name of concealing their sero status, health programmes should embrace similar ‘creativity’ in addressing stigma to enhance uptake of PMTCT, EID and paediatric HIV treatment services if we are to eliminate paediatric AIDS and ensure full and healthy lives for infected children.
Specifically, health facilities should be supported in positive provider interaction, which will in turn improve individual counselling to HIV pregnant women on the benefits of PMTCT, EID and pediatric HIV treatment.
This will help tackle HIV-related social stigma and its devastating consequences.
The MoH also needs to strengthen the ‘Know Your Child’s Status’ campaigns to increase community awareness of the benefits of pediatric HIV/AIDS diagnosis, care and treatment.
Additionally, there’s an urgent need to integrate PMTCT and anti-retroviral treatment services; expand training for primary healthcare workers on PMTCT guidelines together with simplification of treatment protocols such as the recently-launched Option B+; and create linkages to facilitate the continuum of care.
This is critical in achieving a smooth transition between care services and reducing attrition.
Lastly, mobile technology is a new, exciting and cost-effective strategy that has been found to work a variety of resource-limited settings.
Embracing mobile telecommunications to provide appropriate text-based messaging and follow-up phone calls to patients will go a long way in enhancing access to needed information.
The writer is a Communication and Advocacy Officer for the USAID-supported Strengthening TB and AIDS Response in South Western Uganda (USAID-STAR SW) Project, implemented by Elizabeth Glaser Pediatric AIDS Foundation.
The information and views presented in this article are solely those of the authors and do not necessarily represent the views or the positions of the U.S. Agency for International Development or the U.S. Government