Helping Rwanda’s babies have an HIV-free future
By Jenny Clover
Nyamata Health Centre, Bugesera district, Rwanda, September 2011: In the small town of Nyamata, forty-five minutes south of the nation’s capital, a comprehensive programme is in place to give the babies of HIV positive parents the best start in life.
HIV prevalence in Rwanda is relatively low, at three per cent, but prevalence rates are higher amongst pregnant women, particularly in Kigali, the nation’s capital. In an effort to ensure that parents who are HIV positive, do not pass on the virus to their children, Rwanda’s Government has embarked on a nationwide campaign to eliminate the transmission of HIV from mother to child.
“We are especially interested in discordant couples,” explains Dr. Placidie Mugwaneza, Head of HIV prevention at the Rwanda Biomedical Center. “This is a couple where one partner is HIV positive and the other is not. Research shows that new infections among discordant couples are very high. We are targeting them to keep the negative partner negative and treating the positive partner to prevent HIV being passed on the baby during pregnancy or breastfeeding.
“If the mother is HIV negative and the father is positive, it is important for the mother to remain negative so she does not pass it on to her child. And if the mother is HIV positive while the father is not, it is very important for the mother to be supported by the father in receiving treatment for herself and the baby. We ask such couples to come together for testing and treatment because adherence to treatment levels are much higher when there is the support of a partner,” she adds.
At present, the transmission rate of HIV from mother to child in Rwanda is at 6.7%. Rwanda wants this number to go to below 2%
UNICEF has supported Rwanda’s Government to model effective mother-to child prevention and treatment services in 20 of the nation’s 452 health centres. These services, known as the family package, provide everything from home visits, to micro-credit services and psycho-social.
Laurent, 44, a tailor, and Antoinette, 31, a cultivator, came to Nyamata Health Centre in 2005 when Antoinette became pregnant. They were both tested for HIV and Laurent tested positive.
“It was a shock,” he said, “But we received good counselling from the nurses at the health centre. They taught me how to live with HIV and explained to me why I had to use condoms to protect my wife and our unborn daughter. Fortunately, she is HIV free.”
However in 2008, Laurent decided he wanted a son. He persuaded his wife to have sex without a condom and she became pregnant once again. They went through the whole programme again with Antoinette being tested for HIV every three months. Even though she tested negative, the couple received more counselling about why their behaviour was risky to both mother and child.
The couple’s second daughter was tested at 18 months and found to be HIV-free.
“I have promised not to pressure my wife into having sex without a condom again, but am happy though that we have two daughters,” says Laurent.
“As long as we test all couples in our district and provide them appropriate treatment as necessary, we will have a better chance to eliminate the transmission of HIV,” explains Theophile Ndabereye, a health care supervisor in Bugesera.
UNICEF will continue to support Rwanda’s efforts to scale up elimination efforts. At present, 82% of health facilities provide services to prevent mother to child transmission, up from 42% in 2005, and more than 70% of pregnant women can access these services,”
The goal, of course, according to Landry Tsague, Chief of UNICEF Rwanda’s HIV Section is to reach 100% of pregnant women. “Without early treatment, most HIV positive children die within their first two years of life; and children born to mothers with advanced HIV are also more likely to die, even if they are HIV negative,” he explains, “this is why scaling up elimination services will remain our focus for the years to come.”