Roselyne Sachiti Features Editor
Six-month-old Baby Tadiwa was always sick. Prophets did all they could, but still the diarrhoea and cough did not go. Eventually Tadiwa died in January this year and was buried a few metres from her sister, who also died two years ago.
A third grave at the homestead in Buhera, Manicaland Province of Zimbabwe, also belongs to another of Maria Tawirwa’s babies, who all died before their first year.
Tawirwa (32) is concerned.
“People gossip, they say all my babies died of Aids. My husband coughs all the time. Our church does not permit us to visit clinics or hospitals.
“I have an itchy rash and cough.
“My cousin took me to the hospital without my husband’s knowledge. I tested HIV positive. I also have tuberculosis and hide my medication in our granary,” she says.
A story that is supposed to be in the history books of HIV is still being told by Tawirwa yet many interventions introduced in the country could have saved the lives of her babies.
Since 2009, when she had her first baby, religious beliefs pushed her from accessing the life-saving Prevention of Mother to Child Transmission resulting in the death of her three infant children.
She lives in regret.
Tawirwa is pregnant again and on Option B+.
Zimbabwe provides antenatal care in all its 1 643 public health facilities.
But many other women, especially in some apostolic sects who for religious beliefs miss out on PMTCT services, are not so lucky.
Their children are still dying from a disease that can be prevented and managed.
Most have home deliveries and miss out on pre- and post-natal care.
In the 90s, HIV infection in Zimbabwe was seen as a death sentence with virtually no treatment available with children facing high risks of contracting the virus from their mothers before and during birth.
But, after the introduction of Prevention of Mother to Child Transmission (PMTCT) programmes in Africa, mothers like Tendayi Kateketa were the first recipients.
“I benefited from the PMTCT programme over a decade ago when at that time there was not much information.
“It was complicated for HIV positive mothers to access the PMTCT programme due to stigma and discrimination.
“Even the health personnel administering the service were also not very well informed to deal with cases of HIV positive mothers who wanted to enrol on the programme let alone to handle cases of children born with HIV,” she said.
As a result many positive mothers failed to access services.
Some HIV positive mothers were coerced into sterilisation after giving birth.
“I was also sterilised at that time, as my doctor advised me that it was the best option for me as it reduced the risk of an unwanted pregnancy as an HIV positive woman.
“The fact that I successfully went through the PMTCT programme reduced mental stress on me.
“I did not worry about the effects of HIV on my baby as she was born without the virus,” she added.
Kateteka, who is also co-ordinator, Pan-African Positive Women’s Coalition – Zimbabwe Chapter, said while at that time, most HIV positive mothers were not advised to breastfeed their babies and encouraged to use alternative feeding methods such as milk formula, many positive lactating mothers could not afford this route as it was expensive and, above all, was not the best for the baby.
“I took the initiative to educate communities especially pregnant women or those planning to fall pregnant to take up HIV testing and counselling as a precaution for HIV positive mothers to prevent their babies from HIV infection and to promote good health for the mother as well.
“The PMTCT programme has been a huge success in Zimbabwe and we have seen a lot of transformation with the introduction of Option B and Option B+, Option B++, which now calls for all pregnant mothers to be tested for HIV and those who test positive are immediately put on lifelong ART,” she explained.
This, she added, has seen a significant reduction in the transmission of HIV from mother to child.
A lactating positive mother can now exclusively breastfeed her baby for six months and this has also reduced infant mortality as it promotes good health and development for children.
The new WHO guidelines call for all HIV positive people with a CD4 count from 500 and below to be immediately put on ART has also contributed to the reduction of HIV on babies and infants.
However, Kateketa added, despite the above successes, there are still challenges that HIV positive pregnant mothers face.
“These include stigma and discrimination especially for those who might not be able to exclusively feed their babies.
“Because of socio-cultural factors this has also resulted in gender based violence against positive women when they fail to breastfeed,” she said.
She added that there has been loss of follow-up on children who are born with HIV as sometimes the mothers are reluctant to have their babies tested for HIV and they miss out on treatment.
“The PMTCT is also an entry point to ART for the family. It gives an opportunity for couples to access ART and encourages male involvement in the prevention of mother to child transmission for HIV.
“Another challenge we still face today, is also from certain faith communities who because of religious beliefs discourage people from seeking medical services from health centres.
“This has resulted in families and HIV pregnant positive mothers missing the opportunity to prevent their babies from HIV infection and also for them to be enrolled on lifelong ART through the Option B++,” she added.
She said harmful cultural and religious factors that make women vulnerable to HIV infection should be eliminated.
She said human rights-based approaches which ensure that all pregnant mothers and those intending to have children are aware of the PMTCT to increase uptake of service should be promoted. Zimbabwe has made progress in reaching MDGs 4 ( Reduce child mortality) ,5 (Improve maternal health) and 6 ( Combat HIV/AIDS , malaria and other diseases).
SAFAIDS spokesperson Tariro Chikumbirike-Makanga says PMTCT has been very successful in Zimbabwe.
The situation even improved when Government moved from PMTCT to Option B+, which now takes care of the mother’s health as the mother is also put on treatment, she says.
“PMTCT alone used to be where mothers were being used as a conduit to delivering healthy babies, but now with Option B+, Government is now taking care of the mother and baby,” she said.
She added that men’s support was limited mainly due to how the programmes were introduced.
“PMTCT was designed with women in mind than men.
“The gap is also created due to socio-cultural practices where men are not expected to play any role in child birth.
“This should be addressed through engaging men and making them aware of the role that they should play.
“This can be done through dialogues. Women also need to be engaged, for example, mother-in-law, so they do not see it as wrong for their sons to be seen accompanying a woman for an antenatal visit,” she said.
She added that some religious groups are also a challenge as they not believe in seeking health services, with home deliveries being the norm.
“These contribute to new HIV infections in children through missing the opportunity of being enrolled on a PMTCT programme,” she said.
Mother to child transmission accounts for 90 percent of all new infections in children 0-14 years in Zimbabwe, according to the Multiple Indicator Cluster Survey (2015).
Furthermore, it is estimated that HIV and Aids contributes approximately 21 percent to the under-five mortality and 26 percent to maternal mortality in the country.
Zimbabwe developed and adopted the National Strategic Plan for eliminating new HIV infections in children and keeping mothers and families alive 2011 to 2015.
The elimination strategy aims to contribute to the attainment of MDGs 4 (reduce child mortality) and MDG 5 (improve maternal health) and MDG 6 (combat HIV and Aids and other diseases) by 2015.
In the survey, 96,8 percent of women knew that HIV could be transmitted from mother to child.
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