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It takes a team to tackle HIV

A red ribbon for World AIDS Day / Andy McCarthy (

My work in HIV takes up a lot of my time, but it’s not all that I do. I am also a mother and wife and in spite of all I do at work, I always try to make time for my family.

I am married and I have two boys, 10 and seven years old, so when I get home from work, I dedicate my time to family. When everyone is asleep and I am recharged after a few hours of rest, I get up and work on my research. My husband says I never sleep. However, he is very supportive. Mind you, I don’t do research into pediatric HIV all the time, it comes in spurts. It is not an everyday thing.

In saying that, I never go off duty. The babies I care for at Cornwall Regional Hospital are like my own children. My official work day is eight hours, five days a week, but even when I am not in hospital I get calls about patient care.

I had a Caesarean section when I gave birth to my youngest boy; I had just come out of surgery when a nurse called with a question. I took the call. I had worked until the day I gave birth and had just left the hospital a few hours before so they had no idea I had been in surgery.

Teamwork makes it possible

I depend on my team which includes a social worker, a pharmacist, two adherence counselors and a researcher. Even though we have separate roles, we all work together.

Not everyone in the team can be an adherence counselor but everyone helps to identify barriers and encourage compliance. Not everyone can be a social worker but everyone identifies social issues and points patients to the help they need. Not everyone can be a trained pharmacist but we all can identify medications and identify symptoms.

We all help the nurse researcher by each collecting data to ensure the national HIV Response programme can evaluate our project. Not everyone is a counsellor but we all listen to the challenges and try to offer hope.

The social worker is my private investigator. Without her some patients facing challenges would never show up. She visits, calls, acts on information that may lead to a defaulting parent. I call her my hands and feet.

The adherence counselor works behind the scenes, with the parent or pregnant mom to ensure their medications are picked up on time, that they are taking the right doses and try to help with any challenges they experience. These same counsellors will help support babies born HIV positive once they start on anti-retroviral treatment.

A good example of teamwork is late last Friday afternoon when a pregnant mom came in. She was worried her family would question why she wasn’t going to breastfeed her baby. The dietician, social worker and I met with the mother and offered her all the options available. She needed to work it out before the questions came from curious family members. We came up with a solution she was comfortable with. Planning ahead helped to quench her anxiety. This isn’t always the case.

Some mothers who are HIV-positive give into the pressure to breastfeed their babies rather than have their relatives and friends become suspicious and risk their HIV status being discovered.

That is unfortunate, as this result in one more child being infected with HIV which could have been avoided. Fortunately for us at our clinic, this only happened once when a mom breastfed to please her family and formula fed to please the team knowing the risks of transmitting HIV in the breast milk if she mixed formula and breastfeeding.

We suspected that this was happening at the first ante-natal clinic visit as the infant groped for mommy’s breast and on testing the infant we discovered the baby was infected, most likely through mixing breastfeeding and formula feeding.

This is what we try to prevent. Since the prevention of mother to child transmission programme has started the only infected babies are the ones whose mothers failed to comply with the care.

Each team member develops a relationship with the client to the point where they are open and honest with challenges they face. They must trust us so we can help them work things through or they will compromise the entire operation and harm themselves or their children.

Andrea Downer

As told to

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Dr Tracy Evans-Gilbert