Finding life after loss
After losing her husband to an AIDS-related illness, a mother in Cameroon is determined to keep her children healthy and HIV-negative.
EBOLOWA, Cameroon – “Two months ago, I lost my husband Martin,” says Antoinette. “He died of AIDS. Since he left us, my life has changed so much. I don’t live as I used to when he was here. I need to do things now that I shouldn’t do – like asking people for food.”
According to UNAIDS estimates, in 2017 alone, 24,000 people died from AIDS-related causes in Cameroon. 3,300 of them were children under the age of 15.
“I have a small field that I farm. I work to feed my children and it makes me very proud. Even if it’s hard work, I don’t have a problem because I know that after work I’ll be able to prepare a meal for them, so they don’t go to bed hungry,” Antoinette says.
Antoinette has no formal income. With a formidable courage and deeply humbling strength, she holds everything together, attempting to provide for her family physically and emotionally, often with little support from the community.
In 2007, Antoinette first found out her status after her husband Martin was hospitalized and tested HIV-positive. She also tested positive. This, she said, was a harrowing time for them both.
“When I found out I was HIV-positive, I thought that it was the end of my days. I was so afraid of this illness – the illness that kills people. I thought I was going to die and I thought my baby was going to be born with HIV too,” Antoinette says.
Fortunately, when Antoinette became pregnant with her third child in 2013, she met Rose Mekinda, a peer counselor at the Ebolowa Regional Hospital. Mekinda introduced Antoinette to the prevention of mother-to-child transmission of HIV (PMTCT) services at the hospital, and encouraged her to consistently take antiretroviral treatment. The treatment suppresses HIV viral load throughout the pre-natal, labour, delivery and breastfeeding periods, giving her child the highest possible chance of being born HIV-negative.
A gifted and encouraging health worker, Mekinda loves working with women and their children. The key to her success, she said, is that she is able to put herself in her client’s shoes, and can therefore offer them the support they need. Mekinda, who is also HIV-positive, is a living example of hope to the women she meets.
“It’s not the salary that’s important to me. It’s what I can do for these women, the joy I feel when they smile, and that they trust me,” she says.
According to Mekinda, it used to be very difficult to convince mothers to test their babies.
“The results from the test had to be sent far away and would often get lost. This meant long waiting periods for the mothers. It is really important that a mother receives the results as early as possible. There is no time to lose if the baby is HIV positive,” says Mekinda.
For many mothers, this is the difference between life and death for their babies.
Six weeks after Antoinette gave birth to Prisca, her third child, Mekinda encouraged her to test the baby for the virus. Unfortunately the samples could not be tested at the clinic and had to be sent to the referral hospital in Yaounde, which is more than 150 km away. Long distances between health centres and referral laboratories, as well as other logistical challenges, often lead to massive delays in results being returned to health facilities and caregivers, creating delays in treatment.
According to Jean Bosco Elat Nfetam, the Permanent Secretary of the National AIDS Control Committee, “One of the reasons for low performance [of the HIV response] in Cameroon was the failure to diagnose infants early on. Once a patient is diagnosed as HIV positive, treatment should be started as early as possible. Delay in treatment can result in loss of life and high infant mortality.”
Antoinette recalls the arduous time of waiting for her daughter’s results. “The hardest moment was when I was waiting for the results. I couldn’t sleep, I was not myself. I wanted to know my child’s results so badly, to know if she was healthy.”
Week in and week out, Antoinette would walk tirelessly to the clinic to find out if her baby’s results had arrived. Every time Prisca got sick, Antoinette would fear the worst. After three months, there were still no results. Eventually, she was called back to the clinic to test again. Three more months passed, without a result. After nine months, Antoinette finally received the results. Prisca was HIV-negative.
Two and a half years later, Antoinette became pregnant again. She was delighted to hear that she was going to have twins. Thanks to Mekinda’s advice, she took the necessary precautions to maximize the chances of her babies being born without HIV. But when the babies were born and it was time to test them for the virus, Antoinette dreaded the process.
“When I had the twins, I thought I was going to have to go through the same procedure of waiting for my results. Of all the deliveries I've had, I do not have a good memory of the third [Prisca’s]. I experienced all the feelings, the joy of having a baby despite my state of health, the suffering, and the anxiety due to the long turnaround time of the result. I did not want to go through that again,” she says.
In 2016 a new diagnostic technology was introduced into Cameroon to test infants for HIV: Point-of-care early infant diagnosis.
For Antoinette, this meant that she could have her twins tested and receive the results on the same day. It took some time for Mekinda to convince Antoinette that this was possible, but eventually she brought Natasha and Emmanuel in for testing and received their results an hour later.
“When I arrived at the hospital, they tested the twins and after an hour we had the results. I was so happy that it had gone so quickly. I didn’t need to go home and wait. The results were negative. I am grateful to the promoters of this innovation. They may not realize how good it is for mothers,” says Antoinette.
For Lydia Nyatte, Lead Laboratory Technician at the Ebolowa Regional Hospital, the point-of-care early infant diagnosis has been a life-changing intervention. She recalls the old system, which had massive delays for mothers receiving their babies’ diagnoses.
“We are so satisfied with the new system and our ability to test and disclose results an hour later. Children can start their treatment the same day. Not only has this helped save the lives of babies, but we have also seen a huge increase in the number of mothers choosing to test their children. We are receiving more and more samples and this is a good sign,” says Nyatte.
The twins, Natasha and Emmanuel are now healthy 18-month-old toddlers. They love to play and dance and Antoinette loves being a mother. “To be loved is a good thing. I really love my children. Despite the fact that I have had problems in my life, I love talking to them. I ask them questions and they answer me, and they ask me questions and I answer them. Like all mothers, I hope that they will be successful in their lives. I have taught them to work hard and enjoy school."
“Antoinette is a strong woman. I saw her weak for the first time when she lost her husband. But then she told me, “I will stay strong for the sake of my children. She is one of the bravest women I know. Despite her difficulties, she has not given up,” says Mekinda.
Although Antoinette will wear black for the next year of her life, in memory and honour of her late husband Martin, she is thankful that all of her children are HIV-negative and that their future is filled with colour, life and possibility.
Cameroon's point-of-care early infant HIV diagnosis is implemented by Unitaid, in partnership with the Cameroon Ministry of Health, UNICEF, the Elizabeth Glaser Pediatric AIDS Foundation, and the Clinton Health Access Initiative.