Keeping baby HIV negative

In Kenya, Prevention of Mother to Child Transmission of HIV (PMTCT) services are available in all public health facilities free of charge or at a minimal cost. Despite that, not all women receive the full benefit. A number of expectant women refuse to take the HIV test while others fail to return to the health centres for follow up. Some who test positive and are put on drugs fail to take them as instructed for fear of being found out by their partners, other family members or even friends.

Without treatment, the risk of a HIV positive mother transmitting the infection to her child is reported to be 20-42 per cent. However, testing for HIV, which is the first step in the PMTCT programme, has faced different challenges since its inception in the country’s health system. Women who do not know they are HIV positive cannot benefit from PMTCT interventions.

Women refuse to be tested for various reasons

» Fear of learning that they have a life-threatening condition » Some distrust HIV tests » They do not expect their results to remain confidential, and fear stigma and discrimination following a positive result.

» Rose Muhanda, a nurse at Namasoli Health Center in Butere District Western Province, says though the uptake of PMTCT is 90 per cent, several challenges face the success of the programme. At the health centre,- for example, approximately 50 women turn up every month for antenatal care. Testing is on voluntary basis and the women are counselled accordingly before the test.

‘One major challenge we are facing is disclosure for those who turn out HIV positive. We have seen families break simply because a woman tested positive. What the men don’t know is that it would be easier if they accompanied their wives for all the antenatal checkups.’ Even for the few women who accept their status after counselling, drugs adherence is not guaranteed.

‘If a woman is not willing to share her positive status with her partner, PMTCT interventions are most likely going to fail. Even for those who decide to live positively but without disclosing their HIV status to their husbands, it never works out.’

Rose, who has worked at the rural Health Centre for about ten years, says she gets disappointed when mothers fail to take full advantage of the free PMTCT services. ‘Some men do not understand that if their wife is positive, they have been exposed and most likely have the virus. Instead they chase away the woman claiming she has been unfaithful and is a disgrace to the family.’

Feeding options for babies is another problem. HIV positive mothers can either choose to breast-feed exclusively for six months or formula feed exclusively.

Take a practical example: One of the most recommended and easily available brands of formula milk costs about KSh 700. Juliana Kamweri, a mother who has been using the brand on her six month old, tells me a tin would last five days when she started. Now at six months, her daughter consumes a tin in four days. This means two tins in a week, at a total cost of over KSh 5000 per month.

‘This is a luxury that only a few Kenyans can afford,’ says Rose. ‘Sometimes I feel sorry for the mothers.

Yes, they are willing to avoid breastfeeding, but they cannot even afford one tin of formula milk in a month, let alone a week. They end up giving babies cow milk which is neither digestible nor nutritionally fit for them. Eventually, we have children who are malnourished or suffering from other ailments. Some mothers then end up breast-feeding and exposing their children to the virus. It is a sad situation; I wish the Ministry would consider a continuous supply of formula milk in all public health facilities.’

Back in Nairobi, I met Christine Bwana, a school teacher from the Coast Province, who has had to move to the city and live with her husband following the birth of their second child. ‘After I tested positive in pregnancy, we discussed all the options with my husband and decided we would go for formula milk since we can afford it.’ Christine’s husband works and lives in Nairobi while she is a high school teacher. She was lucky to get a posting near her home. So she lives in her own house, from where she walks to school. ‘All was well until I left hospital and my mother in law noticed I was not breastfeeding. At first I convinced her that I was not producing much milk—yet the baby was hungry.

‘However, after a few days, under the watchful eye of my sister in law, they discovered that I was deliberately not making any efforts to breast-feed. We had agreed with my husband not to disclose our status just yet,’ she recollects. Her mother-in-law got furious, because she had been giving her some special herbs to help in milk production. ‘One day she came to the house and insisted I put the baby on the breast so she could teach me how to breast-feed.

I just could not do it. I could not expose my daughter to HIV. I later called my husband and we agreed I move to the city,’ she says, adding that she is trying to secure a transfer to another school.

Such forms of stigmatization have been a major set back to the success of PMTCT. Christine is lucky she had an option. Not all women are as lucky as she is.

Isn’t it time we all accepted that HIV is real? This will go a long way in preventing new infections especially mother to child transmissions. Some women who test HIV positive do not return to clinics for follow up visits or fail to take the drugs they have been given. This can happen because they have had negative experiences interacting with clinic staff or because they have been poorly informed about HIV transmission and how it can be prevented. Some women, having tested negative early in pregnancy can become infected during pregnancy. Without returning to clinics for retesting, treatment is not accessed.

However, with the many success stories of PMTCT, we can only hope that our women take up these lifesaving services offered at public health institutions seriously.

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