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Combating Aids through the unborn

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The message from Stella Nkhata from Chisazima Village, Traditional Authority Kaomba in Kasungu to all women in the country is simple and straight forward: “It is possible for an HIV positive mother to give birth to an HIV negative child.”

Stella, 33, is a living testimony of response to the advocacy by health workers that Prevention of Mother to Child Transmission (PMTCT) of HIV isn’t just a piece of fiction. It is real.

Transmission of HIV from a pregnant HIV positive woman to the unborn child has been identified as one of the key factors in the spreading of HIV around the world. In this case, the virus that causes Aids is passed on to the child during pregnancy, labour, delivery or breastfeeding.

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According to the World Health Organization (WHO), in the absence of any intervention, transmission rates range from 15 percent to 45 percent. Research has however shown that the rate of transmission can be reduced to below five percent with effective interventions during the periods of pregnancy, labour, delivery and breastfeeding.

“These interventions primarily involve antiretroviral treatment for the mother and a short course of antiretroviral drugs for the baby. They also include measures to prevent HIV acquisition in the pregnant woman and appropriate breastfeeding practices,” says WHO.

In response to the need for PMTCT, WHO developed a set of guidelines for countries to follow in the fight against Aids. Malawi made use of the guidelines and has earned global plaudits for its efforts in this regard and for its HIV and Aids response in general.

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In 2014, WHO introduced new guidelines. The measures that existed before 2014 recommended treatment for women of certain CD4 count levels. In these new guidelines, the United Nations body recommended that all pregnant and breastfeeding women should receive ART [anti-retroviral treatment] regardless of the clinical stage of the disease or CD4 count.

This approach was first pioneered by Malawi, perhaps in acknowledgement of the country’s earlier strides, and it has been adopted by most countries with a high burden of HIV around the world.

“As a result,” says WHO, “at the end of 2014, over two thirds of pregnant women with HIV in sub-Saharan Africa were on ART. This coverage level exceeds that for non-pregnant adults.”

People like Stella are products of such interventions.

Following all necessary medical advice, in 2009, Stella who was by then already diagnosed HIV positive, gave birth to an HIV negative baby. As of today the child is bubbling in good health, so as Stella.

And she has a word of advice for women that are in a situation like the one she found herself in.

“When a woman discovers that she is pregnant, she should rush to the hospital to start antenatal clinic where among other advantages she gets tested for HIV. If found HIV positive, she is given necessary advice from medical personnel that would enable her deliver an HIV negative child.

“I am a living testimony to PMTCT because after testing HIV positive when I had just fallen pregnant, I rushed to the hospital, diagnosed HIV positive, put on ARVs and given necessary counseling by medical personnel up to the time in 2009 when I gave birth to a bouncing baby,” she says.

Today, Stella is called mentor mother. She plays a voluntary role of giving PMTCT advice to fellow women to go for antenatal services once they discover they have fallen pregnant so that they prevent transmission of HIV to the unborn baby, thereby helping in reducing the spread of HIV.

“I have gone through a lot ever since I was tested HIV positive, to the point that upon return home from the hospital after testing HIV positive, my husband chased me out of our matrimonial home,” she recalls.

She adds:

“It was hard even to grasp considering that in my life I have never been promiscuous.

“But because I received counseling from the hospital and PMTCT coordinator, I accepted my status and went home to disclose to my husband and my relatives about my situation. It was just unfortunate that my husband chased me out of our matrimonial home. [But] I don’t hold a grudge.”

In her voluntary role, Stella is working with Malawi Network of Religious Leaders Living with or Personally Affected by HIV and Aids (Manerela +) which has among other interventions rolled out its HIV and Aids prevention programmes in the area of Sub-Traditional Authority Chambwe’s area in Kasungu.

Among its HIV and Aids prevention interventions, Manerela+ is promoting PMTCT. The organisation has teamed up with Stella so she could be enlightening women in the area on the advantages of going for early antenatal services to protect the unborn babies from contracting HIV.

Six weeks after giving birth, she had her child tested for HIV where results came out negative.

“I continued following counseling I got from PMTCT Coordinator at Kasungu District Hospital. I was advised to continue breastfeeding the child.

After a year, I had my child tested for HIV where results proved negative.

“Then I was advised to continue breastfeeding up to a year and 8 months where upon completion, I took the child again for HIV testing as per medical advice, where the child tested negative. That was the last test as per medical guidelines,” she says.

As to why she decided to come in the open about her condition, Stella says she wanted as many people as possible to get to know that it was possible to live positively and give birth to an HIV negative child if one follows medical advice as regards to PMTCT.

“Now my child is six years old and in good health. As you can see, I too am in good health. I have never fallen sick to the point of getting admitted to the hospital,” she says.

It was because of her boldness that Kasungu District Hospital medical personnel engaged her so she could help counsel expectant mothers, encouraging them to go for HIV testing once they know they have fallen pregnant, so that they too could give birth to HIV negative babies.

As a mentor mother, she has reached out to many people including traditional leaders and politicians such that she is well known in Kasungu Central area.

Manerela + Programme Office Pirira Ndafera Chiguma says her organisation, with funding from Global Fund through Christian Aid, is working to prevent further spread of HIV using various interventions, one of which is through PMTCT.

“And we thought of working with Stella who has gone through the experience and bears testimony to PMTCT,” she says.

Ndafera Chiguma said the overall objective is to reduce the number of new infections towards elimination of HIV transmission by 2030 and reducing HIV-related morbidity and mortality by 2030

“On Prevention of Mother to Child Transmission we have, apart from Stella, identified other mentor mothers and men peer educators who we are working with throughout the two years we are going to be in the area of Sub TA Chambwe,” she says.

Among other activities, Manerela+ has conducted orientation of mother-to-mother peer educators in PMTCT and facilitated formation of mother groups, men champion clubs and out of school girls clubs.

“The project contributes to the 90:90:90 strategic goals that Malawi adopted,” she says.

In the National Strategic Plan for HIV and Aids (2015-2015), Malawi has set out ambitious targets. The strategy says by the end of 2020, Malawi will have diagnosed 90 percent of all people living with HIV, started and retained 90 percent of those diagnosed on treatment and achieved viral suppression for 90 percent of patients on ART, hence the 90:90:90.

The Manerela+ project is being implemented in Dedza and Kasungu targeting the general population as well as the key affected population including HIV positive mothers and men, sex workers, religious leaders and policy members in the targeted districts.

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