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A challenge to prevent HIV transmission to babies

Dressed colourfully and adorned with jewellery, Mariam, a mother of four healthy children, has a zest for life. It could so easily have been a very different story if it was not for a caring husband and the Government’s “Prevention of Mother to Child Transmission of HIV” (PMTCT) programme.

When Mariam discovered she was HIV positive, her husband supported her although he tested HIV negative. Miriam had been married before and probably became infected with HIV during her first marriage. She had two children with her first husband.

As her second husband had no children, they decided to have two children of their own, despite the risks involved. Mariam completed the full PMTCT programme during pregnancy, delivery and for the period following the birth, when her newborn babies were given prophylactic antiretroviral drugs (ARVs).

After further counselling, she opted to bottle-feed her babies. “If anyone asked me why I was not breastfeeding, my husband would say I had difficulty in producing enough breast milk,” Mariam explains.

Relative to many other African countries Mali has a low HIV/AIDS prevalence rate with only 1.3 per cent of the total population living with the virus. In order to maintain this low prevalence, the Government, with support from UNICEF and other partners, has set up a comprehensive cross cutting programme to tackle HIV/AIDS.

The PMTCT programme is a priority. A child born to an HIV positive mother without any PMTCT intervention has a 30 per cent chance of being HIV positive, but by following triple ARV therapy and bottle-feeding; the risk is only about 3 per cent.

There are 172 PMTCT sites throughout the country in antenatal clinics. But stigma around HIV and discrimination of people living with the virus are major obstacles for the programme in Mali.

Although most pregnant women agree to be tested for HIV, about 65 per cent of those who test positive drop out before the end of the programme. Most abandon it because, unlike Mariam, they feel unable to disclose their status to their husbands or partners. They fear rejection. Thus, the babies run the risk of being infected, women continue to have unprotected sex; and run the risk of re-infecting themselves and their partners.

Moreover, very few men actually test for HIV even when their wives are positive. “Women usually agree to be tested for HIV when they are pregnant, whereas most men only test when they are very sick,” says Dr Soumoula Diawara, who works at the Centre d’Ecoute, de Soins D’animation et de Conseils des personnes vivant avec le VIH/SIDA (CESAC) in Mopti, in central Mali.
Mariam, an accountant by profession, now works for AFAS/AMAS (l’association feminine d’aide ete soutien aux veuves et orphelins du SIDA). She primarily focuses her attention on schools, giving talks to pupils aged 13-16 years. “I tell them to delay sex or use condoms, and I am open with them about my status.”

However, she is under no illusions about the difficulties of shaking the stigma. “I keep my status secret from my husband’s family,” she concedes.

 

 
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