Health feature

By Frazer Potani, Lilongwe, Malawi

Clad in a white napkin and pretty, little green blouse, barefooted eight-month-old Beatrice crawls on a smooth red-oxide cement floor in a house in Chinsapo Township in Lilongwe City.
The little girl moves towards a Mickey Mouse doll in a pink beautiful dress as her mother, Florence, is busy, preparing the baby’s food-mixing Cerelac chuffs with boiled milk, water and some sugar.
Some minutes later Florence plays some tricks to disrupt her baby from the attractive doll, quickly grabs her to feed her.
Baby Beatrice’s story is amazing. She was born without Human Immuno Deficiency Virus (HIV) that causes Acquired Deficiency Syndrome (AIDS) despite her father, Sydney, dying of the incurable disease and her mother also being diagnosed HIV positive!
Sydney did not live to see his daughter because he died just a few weeks before Beatrice’s birth.
Money was not a problem to Sydney because he played his cards safely with the ledger books to earn daily cash.
He was just a mere junior civil servant( Accounts Assistant) at Government Headquarters at Capital Hill in Lilongwe.
Sydney however, died young at Kamuzu Central Hospital (KCH) in Lilongwe after a long illness.
“We got married few years ago soon after he secured a job in one of the ministries at Government Capital Hill, in Lilongwe and died at the age of 27.
People believe that life begins at 40. But this was different with my husband because despite being young, within a short time and getting a poor salary per month, after our marriage we managed to build a three bedroom decent house which has all items a house in the city would need,” said Florence who is 25.
She added that Sydney also left her with a comfortable bank account and a minibus still generating income through operating between Lilongwe Old Town and Chinsapo.
“Before his death, he wrote a will spelling out what I was to get and what his relatives were to get from his estate,” said Florence.
She was however, quick to explain that her husband would have possibly not died early had he listened to her advices.
“Using the money he was defrauding the state he used to drink and womanize. I tried all I could to reason with him of the dangers of womanizing in the face of HIV and AIDS but failed,” said Florence.
She said when she fell pregnant she was filled with an overwhelming joy.

“But my happiness was short lived because when I went to an antenatal clinic at Bwaila Hospital I had my blood tested HIV positive,” said Florence.
She decided to go for Voluntary Counseling and Testing (VCT) after nurses advised her that it was a safety measure for herself and the unborn baby in advance than not doing it until she was to deliver.
“Nurses at the clinic also instructed me to come with my husband. I shall never forget the day that I narrated the matter to Sydney because he wept the whole night for forgiveness. He said he believed he was to blame for infecting me with the virus due to his loose sexual behaviour,” said Florence while wiping tears with a blue Chitenje (cloth) corner, recalling events of that night.
Sydney accepted to accompany her to the antenatal clinic where they were counseled to use condoms to protect the unborn baby from getting infected with HIV and AIDS.
“Sydney died just two weeks before I delivered Beatrice at Bwaila Hospital. Whenever I see my baby crawling on the floor, Sydney’s final statement on his death bed rings in my mind. He said ‘Florence my love I am dying and paying the price for my deeds. But my prayer is that do whatever you can to the child to live a longer, comfortable life before you would also die yourselves,” said Florence.
She said to protect the unborn baby, apart from using condoms during sex with her husband, among other things, was also prescribed with bactrim which nurses at the antenatal clinic advised her be taking twice daily.
“I was told that the bactrim helps to weaken serious opportunistic diseases linked to HIV and AIDS like diarrhea, malaria,”she said.
Around the time she was about to give birth Florence was also administered with a single dose of Neverapine.
This dosage according to Ministry of Health is administered to expectant mothers who have started labour to prevent the transmission of HIV to their unborn babies-same dose that led Beatrice’s miracle birth without HIV.
“I thought that since both late Sydney and I were HIV positive and gave life to Beatrice then she would automatically be HIV positive, instead, I was greatly relieved to give birth to an HIV free baby,” said Florence.
She could not believe that there was a way for HIV positive couples to give life to HIV free babies.
Florence further said nurses also encouraged her to exclusively breast feed her child for six months and her baby put on bactrim too.
“After six months I was advised to stop breastfeeding my child and introduced her to supplementary foods,” she said.
At 18 months Florence is also to go with her child for HIV re-testing and stop giving her the bactrim because beyond that age the medicine is only given to HIV positive children.
“People don’t believe that I look healthy and not yet on Antiretroviral (ARV) drugs. But I still take bactrim as advised by nurses,” said Florence.
She thanks her husband now lying seven feet deep within Chinsapo community grave yard for taking a strong stand to accompany her to the antenatal clinic where they were counseled and followed the instructions that were given to prevent Beatrice from contracting HIV.
“Without his understanding Beatrice would not have been HIV negative and alive today. I have some friends within the neighborhood whose babies died just few months after birth because their husbands refused to practice safe sex with them during their pregnancy to protect the unborn babies from HIV,” said Florence.
She however, disclosed that those who know that her husband died of AIDS discriminate her.
“But l urge those who are in my shoes not to lose hope instead be courageous by living positively with the virus,” she said.
The National AIDS Commission (NAC) says practicing unsafe sex by HIV positive couples during and after pregnancy puts the unborn child at risk of contracting the virus.
“HIV can be transmitted from mother to child during pregnancy, during delivery, and through breast feeding. The desire of HIV-infected couples to have a child must therefore, be balanced with the possibility of having an HIV-infected baby who has a high risk of dying in early childhood after suffering extended periods of illnesses,” says the commission.
The commission further says the death of a parent especially a mother drastically reduces the baby’s chances of survival regardless of the baby’s serostatus.
“It is important therefore, that interventions address treatment for parents, in addition to Prevention of Mother To Child Transmission(PMTCT) so as to minimize orphanhood and improve the chances of child survival,” says the commission.
The commission also says the starting point for a couple that would like to have a child is first undergoing for HIV VCT and early attendance of antenatal services at a clinic.
“HIV testing should be routinely offered to all pregnant women attending antenatal clinics unless they specifically choose to decline. There should also be promotion and strengthening of programmes that aim to prevent HIV infection and unwanted pregnancies especially in young women of childbearing age,” says the commission.
It further says HIV positive couples should always practice safe sex using condoms during the woman’s pregnancy and beyond and take interventions such as provision of Neverapine administered to mothers prior to delivery if they are to produce HIV free babies like Beatrice.
“Male and female condoms can prevent both unwanted pregnancies and Sexually Transmitted Infections (STIs), including HIV. To be effective, condoms must be of good quality, and properly and consistently used,” says the commission.
A research by the Washington (United States) based Population Reference Bureau (PRB) says for many HIV infected women-who may learn of their HIV-positive status only when they become pregnant –choosing whether or not to have a child is among the toughest decisions they make.
“Mother-to-child transmission of HIV is by far the most common mode of HIV infection for children below the age of 15. More than 4 million have died since the epidemic took hold over two decades ago. These numbers will likely rise as the number of HIV positive women of childbearing age increases. Without treatment, 25 percent to 35 percent of children born to HIV positive women in less developed countries become infected,” says the Bureau.
The Bureau adds that a baby may contract the virus during pregnancy, labour, delivery or as a result of breastfeeding.
“Of infants who become infected, two-thirds are infected during pregnancy and at the time of delivery, with labor and delivery being the time of greatest risk. Research suggests that vaginal deliveries may increase risks of transmission of the virus from the mother to child,”says the Bureau.
The ministry of Health in Lilongwe says utilization of family-centred PMTCT services is an entry point to HIV prevention, treatment and care for all members of the family.
“Family-centred PMTCT are conduit to reaching not only women and children through the maternal and child services but through the maternal and child services but also partners, children and dependants to the households,” says the ministry.
The ministry discloses that without PMTCT interventions an estimated 30,000 babies in Malawi will acquire HIV infection during pregnancy, labour, delivery and breast feeding in estimated 600,000 pregnancies annually. Malawi’s Principal Secretary for Nutrition, HIV and AIDS in the Office of President and Cabinet (OPC) Mary Shawa said a research world over has revealed that birth by caesarian reduces the risk of mother to pass HIV to her baby.
She however, said poor developing countries like Malawi have no capacity including adequate resources to perform such delicate and expensive operations on expectant mothers to reduce their babies’ risk of catching HIV.
“Even where resources are there it’s not automatic to give birth by caesarian because a pregnant woman has to be consulted to seek her consent first before undergoing delivery through this process,” said Shawa.
She disclosed that through PMTC Malawi HIV positive mothers are bearing HIV negative babies and transmission of the virus from mothers to children has been reduced from between 30 and 35 percent to just around 2 percent.
Shawa said PMTCT is an integral part of maternal and child health services of all health facilities.
“PMTCT assists those who test negative to stay negative and those who test HIV positive to improve the quality of life by accessing treatment, care and other support services,” she said.
However, Shawa said if HIV positive mothers are to deliver HIV free babies and the quality of life improve through PMTCT they should be supported by all members of society including their husbands.
And she is right because if late Sydney was having unprotected sex with Florence during pregnancy surely little Beatrice would have not been born HIV free,healthy baby who would energetically crawl on the floor towards a pretty Mickey Mouse doll!

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