Thirty-seven-year-old Christine* sits calmly, looking younger than her age. The baby in her arms breaks her through her calm with his restlessness. She has come to the hospital to get a second HIV test for her son. “Is he safe?” she ponders. She has breastfed him with the guidance of the doctors despite being HIV positive so she is not sure if he has survived acquiring the virus.
“He is one year-and-four months old. I never wanted to breastfeed him because I knew that if I did, he would get the virus and I did not want him to be infected like me but doctors encouraged me and I prayed to God that all goes well. Still, I am worried that he would be infected,” she says.
Christine did not know that the man of her dreams had the virus. A mother of three now, her first two children are free of the virus but she says her first child survived by God’s mercy.
“I did not know my HIV status or my husband’s at the time. When I got pregnant, I was not tested. I gave birth and went ahead to breastfeed my baby. One year later, I found out I was HIV positive,” she narrates.
Luckily enough, her child never got the virus. With her second pregnancy, she did not breastfeed because she knew she would transfer the virus to her. As she waits for the results of her third born, she wonders if her son will be as lucky as the first.
Option B+ policy
Christine is among the approximately 100,000 pregnant women living with HIV who are being targeted to enroll onto the Option B+ policy. The policy, which was rolled out in 2012, provides life-long anti-retroviral (ARVs) drugs to the mother as she continues to breastfeed her baby in a bid to achieve elimination of mother to child transmission of HIV.
According to Dr Emmanuel Mugisa, the prevention of mother-to-child transmission (PMTCT)oordinator at Baylor Uganda, breastfeeding as the main method of feeding a new born baby is one of the ways through which a baby can be infected with the virus. Between 30 per cent and 45 per cent of the children who are breastfed by their HIV positive mothers get the virus. This leaves between 60 per cent and 70 per cent of the children virus free.
Why virus may be transferred during breastfeeding
Dr Moses Galla, a clinical officer at Mulago hospital explains saying there are a number of factors that can lead a mother to transfer the virus to the baby during breastfeeding, one of which is mixed feeding.
“Below the age of six months, the baby’s feeding system is immature and other feeds other than breast milk irritate it causing ulcerations or wounds in the stomach and mouth. These wounds can pave way for the virus to get into the baby’s blood hence infection,” he explains.
In addition, Dr Galla points to a low CD4 count, the stage of the virus and a high viral load as other contributing factors to the transference of the virus to the baby. He explains that if the virus is in the aanced stages of three and four, there is a higher chance of the virus being transmitted. In addition, if the mother has just got the virus and is in the first two years of acquiring it, there is a high viral load which also increases the chances of transferring the virus.
Despite all these contributing factors, Dr Mugisa says Option B+ reduces the risk of transferring this virus to the baby by five per cent in breastfeeding women. A treatment strategy of HIV transmission elimination, Option B+ is done irrespective of the health status or the CD4 count of the mother.
How the policy is doing
“In 2009, we had Option A in which a mother was given drugs until she gave birth and then she stopped. However, when an infected person stops receiving the ARVs, the virus grows again which increases chances of getting the virus on the next pregnancy. Under Option B+, a mother receives the drugs even after giving birth and all throughout breastfeeding. The baby is also given a syrup, under this strategy, which it takes for six weeks and is administered two hours after delivery,” Dr Mugisa explains.
And so far, the results are promising, Dr Mugisa says. In 2011, there were 15,000 new HIV infections in children accounting for 18 per cent of new HIV infections countrywide. After rolling out Option B+ in 2012, there are currently less than 8,000 new infections, he adds.
However, Uganda which subscribes to the millennium development goals is supposed to reduce new infections in children by 90 per cent by 2015. Although the results are promising, Dr Mugisa is skeptical about Uganda achieving this by the end of next year.
“To reduce on these infections by 90 per cent, we need to have less than 2,000 new infections by 2015 which I think may not be possible but it might be achievable in the next two or three years. This means we are on the road to having an HIV free generation,” he says.
It’s going to take more than this policy
However, whereas having an HIV free generation is a good notion, Rosemary Kindyomunda, the national programme officer-HIVAids at United Nations Population Fund (UNFPA) says giving birth to children without HIV is just one way of achieving this. She says there has to be a health system that captures everyone from the time of birth to death to ensure that even those born HIV free remain negative till they die.
“Today, there are no priority programmes for adolescents, focus for now is on children only. Everything has to be emphasised to have an HIV free generation. You can’t achieve and sustain a free HIV generation if there are unwanted pregnancies and there is primary infection in adolescents, adults and youth,” she said.
Dr Godfrey Esiru, Coordinator of prevention of mother to child transmission of HIV at the Ministry of Health notes that rolling women on Option B+ and having an HIV free generation requires routine testing for individuals which is still low. The 2011 Uganda AIDS Indicator Survey (UAIS), states that 66 per cent of women and 45 per cent of men between the age of 15 and 49 tested for HIV. Although the number has gone up, Dr Godfrey states that testing is still a major issue.
“HIV testing is still a big problem. As the ministry, we are partnering with civil society organisations to increase coverage. The biggest problem is that partners in relationships end up using their partner’s results to find out if they are fine or not. For example when a pregnant woman goes to test because it is a must, if she is negative and tells the husband, he will think he is negative too,” he explained.
Getting tested is critical
If Christine had not been tested during her second pregnancy, there is a 45 per cent chance that she would have transmitted the virus to her other children, including her son whose results she is waiting on. She finally gets the results and her baby is HIV negative. Tears roll down her face in relief as thanks God for taking care of her and her family.
Still married to the same man, Christine is thankful that none of her children is infected, unlike her co-wife who has at least one child already infected.
Living with HIV is not an easy thing, but knowing that your children are also infected makes it even harder. The fact that none of hers have the virus is more than reliving but the testimony goes mostly to her third born, her son with whom she used Option B+.
“HIV prevention is about personal responsibility. Unless an individual takes the responsibility to go for constant testing when pregnant, go back for treatment when found positive, feed the child well so that they do not grow up desperate and look for older men who may infect them with the virus, the vicious cycle of the virus will continue,” Kindyomunda concludes.
World Aids Day
World AIDS Day is held on 1 December each year and is an opportunity for people worldwide to unite in the fight against HIV, show their support for people living with HIV and to commemorate people who have died. World AIDS Day was the first ever global health day and the first one was held in 1988.
SOURCE: Daily Monitor