Breaking the HIV transmission cycle

One of the key successes of this initiative lies in educating the mothers, who in turn, share their knowledge with their communities and other HIV+ mothers.

Astrid de la Rey
HIV testing in a health facility
UNICEF Eswatini/2017
09 April 2020

In the country with the highest HIV infection rate in the world (27.2% of Eswatini’s population lives with HIV), the issue of mother-to-child transmission urgently needs a spotlight.

At the Baylor clinic in Mbabane, 28-year-old Nobulelo Malaza has brought her 2.5-year-old son to the monthly Mother Baby Club. Both are HIV+ and this is their only source of support, information and care as they face life with HIV.

According to Nobulelo, “Finding out that you are HIV+ is not easy but knowing that you have given it to your child is soul-destroying. I have been coming to the Mother Baby Club since my child was six months old and it has been a great source of comfort, hope and assistance when we needed it the most.”

The Baylor Mother Baby Club is the brainchild of Dr Jaime Petrus and has been in operation since 2017. According to Dr Petrus she started the Mother Baby Clinic because she firmly believes in treating mothers and babies as pairs. “Many programmes focus only on the child, but if we use a more holistic approach by treating the mothers and babies together, I think we stand a better chance of educating and minimising mother-to-child transmission. At the end of the day no child deserves to be born with HIV and no mother should carry that burden. It is our goal to help those already affected and eventually stop transmission entirely,” she says.

Every month, a group of mothers and their infants – all of whom are HIV+ - meet at the Baylor Clinic in Mbabane to discuss the issues that affect them. Topics range from family concerns to shared advice on the best way to administer HIV medication to infants.

Hand holding HIV test results
UNICEF Eswatini

“Before joining this club, I felt completely alone’” says Nobulelo, “the father of my child refused to admit this is his son and when my family found out that I have HIV they chased me away. Things have since gotten better with my family, but I still did not know how to care for a baby with HIV. This group has been my anchor.”

Many of the mothers can’t afford transport to get to the clinic, so transport is subsidised for all members of the Mother Baby Club. “It is vital that these mothers and children attend as it is the only way we can ensure they follow the correct treatment and avoid re-infection. It is also the only way we can educate them about viral loads and the possibility of re-infection and how that will affect them,” says Petrus.

For the mothers it is a welcoming and safe space where they are free of judgement and can share their hopes and fears with people who are in the same situation. “It sounds silly,” says Nobulelo, “but one of the biggest problems is that the medicine for the babies tastes terrible, so it is very difficult to give to the children. The mothers give each other advice and tips on how to make sure the medicine stays down. This is important, because we have to make sure our children take their medicine, but it can be a challenge and we help each other.”

In addition to the many discussions around HIV treatment, the mothers discuss many other concerns. “A nurse facilitates during the Mother Baby sessions and is able to give medical advice on topics ranging from cervical cancer, to breastfeeding and menstrual hygiene,” says Zandi Nhleko, Programme Manager for Baylor. “One of our key educational targets is the importance of knowing your viral load. When HIV+ women fall pregnant they don’t realise that the level of their viral load determines whether they will pass the disease to their unborn child. This is a crisis! We need women to understand how crucial it is to monitor their viral load – not only during pregnancy but also during breast feeding and throughout their lives, to avoid re-infection, which many HIV+ people don’t even realise is a possibility.”

“Before joining this club, I felt completely alone. The father of my child refused to admit this is his son and when my family found out that I have HIV they chased me away." 

Nobulelo Malaza

For the success of this Mother Baby Club initiative, like for so many other HIV interventions, the level of literacy plays a critical role in understanding the importance of proper adherence to treatment. Bhekumusa Lukhele – the Executive Director of the Baylor College of Medicine and Children’s Foundation in Eswatini says, “One of our biggest tasks in the Mother Baby Club is making sure that the mothers understand how and why they and their children should take their medication appropriately.”

One of the key successes of this initiative lies in educating the mothers, who in turn, share their knowledge with their communities and other HIV+ mothers. “The fact that the mothers are starting to educate one another and those around them, gives me hope that we are achieving something great,” says Dr Petrus, “we are by no means anywhere near where we should be in containing this epidemic, but peer-to-peer education is one of the best ways to fight it from the ground up, and we are on track to achieving that.”

For Nombulelo and her son, the Mother Baby Club plays a grounding role in their reality: that they will both face the rest of their lives living with HIV. “When the time comes that I have to explain this to my son, I know I will be prepared and have support,” says Nombulelo “Telling my son that I am the reason he has HIV will probably be the most difficult conversation of my life, but I will do it and I will educate him so that he doesn’t have to have the same painful conversation with his own child someday. That is the true gift of this Mother Baby club – that I am now empowered to break this cycle of HIV transmission, because I now have the knowledge, the support and the courage to do so. It will be the best gift I can ever give my son.”

UNICEF Eswatini provides financial support to Mother Baby Club members to subsidise their transportation to constantly attend the club activities and also supports the education sessions with materials. UNICEF intends to extend the reach of this initiative to include pregnant adolescents and lactating mothers to ensure that mother-to -hild transmission of HIV is eliminated and that children with HIV receive quality care and love from their mothers /caregivers.