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Struggling to stop babies being born with HIV

Uganda: 150,000 children are already living with HIV / Liba Taylor – Panos Pictures

In Uganda, late testing and patchy antenatal provision are putting more mothers and children at risk.

It is mid morning in the Namatala suburb of the eastern Uganda town of Mbale and a bunch of happy children, including five-year-old preschooler Joy, are playing. Joy is HIV positive.

Although Uganda’s Prevention of Mother to Child HIV Transmission (PMTCT) programme did not save her from infection, she was lucky to be diagnosed early enough and given treatment.

Joy’s mother Esther was already eight months pregnant when she enrolled for antiretroviral drugs. “I learnt of my positive status late into the pregnancy and could not get treatment immediately,” she says, “because I was told that some tests [CD4 count] had to be done before starting me on the drugs. But as money was not readily available to travel from the village to go for the tests I delayed further”.

Joy is now among an estimated 150,000 children living with HIV in Uganda, 50,000 of whom need life-prolonging antiretroviral therapy. Currently only 12,000 are getting the medicines because many parents or caregivers are not aware of the status of the children.

Nearly all paediatric HIV infections in Uganda are the result of mother to child transmission. Many expectant mothers do not know they are HIV positive – in fact only 12 per cent of adults in Uganda know their HIV status – so they do not use PMTCT services. As a result, nearly 30,000 infants are born with HIV every year.

The chairperson of Uganda’s parliamentary HIV and Aids committee, Dr Elioda Tumwesigye, has emphasised that the very small percentage of adults who know their HIV status is a major challenge. “As long as a high number of people in the reproductive age bracket continue to be ignorant of their HIV status, the number of children born with HIV will continue growing,” he said at the committee’s launch in May.

Husbands stop wives taking tests

Each district in Uganda has at least one centre which delivers PMTCT services. According to the country’s annual health sector performance report for 2006 and 2007, around 80 per cent of clients attending antenatal clinics took an HIV test.

But many women are not seen by health providers or do not get the recommended four or more antenatal sessions. The overall number of women tested for HIV during pregnancy was around 35 per cent. Similarly, less than half of all births are accompanied by skilled attendants, essential to prevent the transmission of HIV from mother to child during labour.

James Kigozi, spokesperson at the Uganda AIDS Commission, says, “In some centres, we have received reports that sometimes there are shortages of testing kits. And if a woman comes and there are no kits, she may not come back because women travel long distances to come to these health centres”.

“You may also find that this woman could have used the chance of her husband not being around, to go for testing. When she misses that opportunity she may not go back because the husband may not allow it. In some of our communities women still need to seek the permission of husbands each time they want to move out, especially in rural areas.”

A survey conducted late last year by HEPS Uganda, a consumer organisation which advocates for health rights, identified three major barriers which serve to exclude women from PMTCT programmes.

“The first stage of exclusion has been because the services are provided through formal health facilities, where only a small proportion of pregnant women seek services. The second stage is where the pregnant women still have the right to decide whether to test for HIV, and many continue to decline the test. Now the third stage seems to have emerged, where some of the already few women who consent to an HIV test reject the results if they are positive,” reads the report.

Early diagnosis crucial

The Uganda Joint Clinical Research Centre (JCRC) has embarked on a countrywide campaign calling on parents and caregivers to take children for free testing and treatment. Early diagnosis of children with HIV, as was the case with Joy, means they can start taking medication quickly and it reduces the risk of complications.

“We are targeting children who are born to HIV positive mothers, children who have been orphaned by HIV and AIDS, sickly children with recurrent fevers, coughs and diarrhea, who are growing poorly, and children who have been at risk,” Dr Victor Musiime of JCRC says. “There are many children out there who may be positive or negative. People are not sure what treatment to give them, they are not sure what to do but…when you get to know their status, you will act better,” he adds.

Dr. Mike Kagawa, a specialist gynaecologist and obstetrician at Uganda’s Mulago National Referral Hospital in Kampala, says infants should go back to hospital for monitoring after receiving an HIV positive diagnosis. “It is advisable that they are taken for review every two weeks initially. They are put on trial drugs to see how they cope and if this succeeds then they visit the hospital on a monthly basis,” he says.

The indications are that Uganda still has a long way to go to reduce infection among children. Those in charge of Prevention of Mother to Child Transmission programmes need to get better at testing women early in pregnancy. Strategies must be put in place to ensure testing equipment is available in these facilities at all times and pregnant women who are positive enrol for treatment.

This is an edited version of an article published by the

Panos Global Aids Programme’s 2010 features.

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Kakaire Kirunda

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07/23/2008

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