Reaching out to expecting mothers
WAMENA, 14 November 2011 - Wanda (not her real name) was 32 years old and eight months pregnant with her second child, when her husband discovered that he was already in an advance state of AIDS.
At the urging of the doctor and nurses at Wamena General Hospital, in the highlands of Jayawijaya in Papua, she took the same test and discovered that she, too, had contracted HIV. She was quickly given the required medications for the rest of her pregnancy, and had to have a caesarean childbirth.
Her husband died a few months after she gave birth, but the baby boy was found HIV-free when he was tested 19 months later.
“I was very relieved that he did not get sick from me,” said Wanda, who is now staying at a shelter for people living with HIV while undergoing treatment. To protect her baby, who is now being taken care of by her mother in the village, she does not feed him her breast milk.
It was a close call: if she hadn’t taken the test, she might have transmitted the virus to her baby. Protecting babies like hers from contracting HIV from their mothers is the goal of UNICEF’s Prevention of Mother to Children Transmission of HIV (PMTCT) programme in Papua and West Papua.
“The PMTCT programme has been going on for a while, but the concern has been the quality, the capacity and the system to drive it, which is the added value that UNICEF has been bringing since last year,” said Dr. Tajudeen Oyewale, UNICEF HIV and AIDS specialist for Papua and West Papua.
“If the treatment regimen is done correctly, started on time, given the right dosage and with good monitoring, we can cut transmission by 95 per cent,” he added.
According to the Head of the Department of Health Office in Jayawijaya District Agus Naronggear, the PMTCT programme has improved much in the past year, with public health clinics and hospitals now required to provide HIV test to pregnant women.
Currently there are almost 1,400 people known with HIV in the Jayawijaya District and the surrounding mountainous region of ‘Pegunungan Tengah’ in Papua. Twenty per cent of health cases in the hospital are HIVand AIDS related, he added.
In Jayawijaya District, out of some 800 pregnant women tested for HIV in public health clinics and its general hospital this year, at least 45 were found positive (approximately 6%).
The new approach calls for appointed public health clinics and hospitals to provide Voluntary Counselling Tests (VCT) to expecting mothers who come for antenatal care, and counsel them to take the HIV rapid test, which takes about 10 minutes.
If the women were found positive, they would then be referred to the midwife or doctor in charge, who would prescribe them with the medication Co-trimoxazole Prophylaxis, and put them on a course of antiretroviral therapy (ART).
“The earlier they are identified as being HIV positive the better, so we can plan the course of treatment during their pregnancy, and prepare the C-Section when they deliver their babies,” explained Theresia Resubun, who is in charge of Maternal and Child Health in Wamena Health Clinic.
On this particular morning, Dekilena Wandik, 26, who was eight months pregnant with her sixth child, had walked the two-hour distance from her home to the clinic with her husband for the antenatal care. After counselling with the clinic’s head, Dr. Derry Sihombing, she agreed to take the HIV test. To the couple’s relief, the results came negative.
Her husband, Titus Kogoya, 27, who was studying to become a church clergyman, was open about his past behaviour leading him to fear that his wife might be HIV positive.
“I used to play around, but I don’t do that anymore because I am a servant of God now,” he said.
Out of some 750 women who came for the antenatal care at the clinic this year, only half of them had agreed to take the test.
According to midwife Theresia, many women are often reluctant to take the tests, fearing their husbands would be angry if they find out about the results. But they should not be, because the test result is confidential even to the women’s own husbands, she added.
Of the women who took the test at the clinic this year, 15 were positive and two had given birth to HIV-positive babies. Only one of the babies survived.
The women found with HIV are referred to the General Hospital for C-Section delivery. VCT Counsellor at the General Hospital Nurhayati Hasan said many of the women who were found HIV positive were already 30 weeks pregnant.
“Ideally they should start taking the ARV medication since 14 weeks of pregnancy for greater chance of reducing transmission to the baby,” she said.
Babies born to HIV-positive mothers can only be tested when they are 18 months old, so before they are tested, it is important that they receive prophylaxis treatment, and that they are not fed with the mothers’ breast milk, Nurhayati said.
In some parts of Papua such as the coastal city of Manokwari, the number of women getting HIV tests while seeking ante natal care reached 100 per cent, twice the rate in Wamena.
But Dr. Oyewale of UNICEF is positive that things will get better: “Fifty per cent is good news for me initially.”
“In August last year, when I was at the same centre, we hardly had 5 per cent test rate,” he said, attributing subsequent progress to “intensive awareness.”
Dr. Zanty Manuputti, who is in charge of VCT in Wamena General Hospital, said the language barrier and a lack of education also make it hard for many HIV-positive women in Jayawijaya and the surrounding mountain areas to undergo their course of treatment properly.
“Many of them don’t read or write, and only speak their dialect. Often they take their medications improperly, making the medicine ineffective,” she said.
Some women even stop coming for their monthly check after a while, making it hard for the hospital to continue monitoring their progress, she said.
“There is still the classic geographical and transportation problems here; it’s hard for many people living in remote mountain areas to access health facilities,” said Agus Narrongear of the Department of Health Office in Wamena.
Dr. Tajudeen admits that the programme needs more capable health workers, better coordination and local government’s ability to put in the required investment to sustain the approach.
“PMTCT is not just a health sector response, it also requires family support, community networks and more, because this is the future of tackling HIV,” he said.
The programme’s success will ensure a new generation that will be HIV free, he added.