Prevention of mother-to-child transmission: Given hope by Ruth Ayisi Beira, Sofala Province - The picture looks idyllic. There is a young couple with their lively daughter, sipping soft drinks in a café overlooking the Indian Ocean. At one year and eight-months, Lydia is a typical toddler, vying for attention and unable to keep in one place for longer than a few minutes. “My dream is that my daughter will live,” says 26-year-old Maria. Later, Maria was to learn why her son died. Both she and her husband tested HIV positive, and thus there was a strong possibility that her son died of AIDS-related illnesses. “At that point, we just both thought about death,” says her husband, João, who is a policeman. (The names of the family have been changed to protect their privacy). Despite efforts to practice safe sex, Maria, became pregnant again. She says she was very depressed and anxious for her unborn baby, until one day she heard on the radio about a project to prevent HIV positive mothers transmitting the virus to their babies (PMTCT). The Government started the project, which is supported by UNICEF and run in collaboration the NGO Health Alliance International, in the provincial hospital of Beira, a port city, which – at one sentinel site – recorded an HIV/AIDS prevalence rate of 35.7 per cent (data from 2002), the highest in the country. On the whole, UNICEF supported Government counterparts, local and international partners in opening 15 new Prevention of Mother-to-Child Transmission (PMTCT) centres in 2004 bringing the total number of supported sites to 20. The total number of PMTCT services operating in Mozambique reached 44 at the end of 2004. The programmes use the anti-retroviral drug Nevirapine which reduces the chance of mother to child infections by 50 per cent. Without the drug, up to one in three women will transmit the virus to their child. Thus, Nevirapine is not the most effective drug, but it is cheap and easy to administer, an important consideration for Mozambique, one of the world’s poorest countries, where only 45 per cent of its 19 million people are covered by the basic primary health care system. When the PMTCT programme is unrolled throughout the country, it will significantly reduce the number of babies born with HIV. At the moment, an estimated 30,000 babies are born with HIV each year. Fifty per cent of them will die within the first year of life. The programme also offers the possibility of anti-retroviral triple therapy to parents who have CD4 counts below a critical level, usually 300 for a pregnant woman and 200 for the father, prolonging their lives and thus not further adding to the orphan crisis. Around 270,000 children have already lost their mother, their father or both parents due to HIV/AIDS in Mozambique. Maria says her CD4 count is still relatively high, so she does not need ARVs yet, but she is closely monitored. Maria says the programme gave her the hope that the family so much needed. She attended all the consultations with her husband’s support. Just before delivery she was given Nevirapine in drug form. The baby immediately was given the Nevirapine syrup. Maria received counselling about infant feeding. Following Mozambique’s policy, she was advised to opt for exclusive breastfeeding for the first four months, when taking a substitute would not be safe. Before and after Lydia’s birth, Maria and her husband attended two-hourly group counselling sessions every two weeks. “My husband has been very supportive,” says Lydia. The counselling sessions are important in that they empower the mothers and fathers to deal with the challenges of living with HIV/AIDS especially in a society where stigma is still a major obstacle. Indeed, not even all the husbands are as supportive as Maria’s. The women often find out their HIV status first when they attend prenatal consultation. When they tell the father of the child, the men sometimes blame their wives and refuse to get tested themselves. Augustinho Cunguara, a counsellor on the PMTCT project, says that some few husbands on hearing that their wives were HIV positive even threw them out of their homes. However, attitudes have dramatically improved over recent years, especially among those who are coming forward for treatment or who are participating in the PMTCT project. “Before, there was little hope for people living with HIV/AIDS. But now I see a huge difference”, says Cunguara. “The pregnant women and mothers come in their best clothes to the counselling sessions. They come with hope.” Yet, like the other 100 mothers who had delivered babies by 2004, Maria had to accept that it is not 100 per cent sure that her baby will be free of the virus. She has had a difficult wait of 18 months. With the rapid tests which are used in most of Mozambique including Beira, only at this age, the HIV status can be diagnosed certainly. Four mothers who took part on the same project lost their babies in the first weeks of life. The babies suffered severe infections with complications. “I used to be worried every time my baby got a fever. I kept thinking she was developing a serious problem,” says Maria. Lydia has remained healthy, and each of her three HIV tests taken over the required 18 months came out negative. “My first reaction was that I didn’t believe it”, says Maria, smiling at baby Lydia, who is becoming increasingly restless. Her father, João, holds his daughter on his lap as he remembers the day of the final test, “I was very worried all day, but the result made me very happy. I knew then that our baby is going to live. I feel mentally free now.”
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