Food for Thought

Last week I was observing in VTC (voluntary testing and counseling), essentially the place where they test for HIV. The process looks a little something like this: person X sits down with one of three counselors, they collect some basic info and ask them why they’re there. Most people respond with “to do a test”, to which the counselor says, “what kind of test?” Once it’s clear they’re there for an HIV test the process continues. The counselor explains very briefly what HIV is, in that it’s a virus, not a disease, and it attacks the body’s defense system. They use this analogy: We have soldiers in our body that fight infections; HIV attacks and kills our soldiers. When the body doesn’t have it’s soldiers, it has a hard time fighting diseases and infection. They explain how HIV is contracted, through human fluid or blood. They further explain what that means; HIV can be passed from a positive mother to her child during pregnancy, through unprotected sex, blood transfusions that have not been properly screened and sharps that have not been properly sterilized such as blades and scissors from barber shops. Side bar on that, it’s very common for men to go to a barber to have a shave. And when I say shave, I mean old school, single blade shave. There are many cultural misconceptions about what HIV is and how you get it. For instance, some people believe it’s a curse caused by evil spirits and spells, while others believe it’s a disease that can be contracted like the common cold. There are so many people who are shunned from their families and communities when they become aware of their status. It’s for this reason, some people would rather not know than live in potential isolation and shame. Some who do learn of their status will go so far as to keep it from their marital partner, afraid they will leave them if they find out. So anywho, they go through this informational session and then are sent around the corner to do a rapid test. About fifteen minutes later the results are out and they return to the counselor, who then delivers the news, positive or negative. If it’s positive they’re sent to the clinic’s main building to do a second confirmation test. Sometimes the rapid test will show a positive result when it is actually negative; these cases are pretty rare, but it can happen. If it’s negative they will tell them to return in six months to take a second test, allowing for the “window period” in which HIV can develop.
So anyways, there was this one woman who had her baby with her, still breastfeeding. Actually she was feeding her while was being counseled. Also really common, women will fully whip out their breast in the middle of a conversation, a doctor consultation, in the waiting room, on the street, in the market, just about anywhere. They were speaking in Hausa so I was catching the translation in bits, but basically her daughter is a year and a half, the mother didn’t know her status when she was pregnant and has been breastfeeding since birth. Cut to the diddy about HIV, what it is, how you can get it and she was off to do the test. When she came back to the room, she handed him the folded piece of paper that had a big black stamp that read “HIV positive”. The counselor then advised her to have the baby tested. Again, she came back with a folded slip of paper, and it read “HIV positive”. I could have cried right then and there. I was looking at a beautiful baby girl, not even two years old, and HIV positive. It was totally surreal. How could this be? It’s just not fair! I wasn’t quite sure how to sift through the relentless waves of emotion, one right after the next. It was inconceivable. Later that day I did an inquiry and found out that at Faith Alive alone, there are over 200 children receiving ARV drugs. Children with HIV. The words ‘cruel’ and ‘unjust’ come to mind, but even that doesn’t seem to capture the gravity of how I feel about this said reality.
MTCT (Mother To Child Transmission) can happen at several different stages.
It’s possible transmission can occur in the womb, during delivery and/or through breast milk. If no precautions are taken, there is a 45% chance the baby will be infected with HIV. If a mother is aware of her HIV status and is taking ARV drugs during her pregnancy, the baby’s chances of contracting HIV are significantly reduced. There are special birth attendants, trained in a particular delivery procedure that can then reduce the chance of transmission during birth. Just by eliminating breastfeeding and substituting strictly with formula, the chances of the child contracting HIV is reduced to 30%. If all the above precautions are taken there is only a 2% chance the baby will contract HIV from her mother. So, what are the challenges? Well, number one, the mother must know her status. If a mother is pregnant and knows her status she is automatically placed on ARV drugs. Okay, so let’s say a mother knows her status, now she needs to be receiving pre-natal care and counseling on the advantages of using a trained birth attendant. This in and of it’s self is a huge battle. Many women don’t go to the hospital to have their child let alone get pre-natal care. Cost of medical care and transport to and from the hospital are just a few of the obstacles. But let’s just say for the sake of example, she knows about Faith Alive and gets hooked up with pre-natal are and a trained birth attendant. Now we move into the issues associated with formula feeding. Number one, it’s not widely accepted, and by that I mean culturally. Many husbands and extended family members will pressure a woman to breast feed, because it’s just what you do. There’s ‘no reason’ not to. Then add to that the cultural sigma of HIV and you have pressures coming at you from every direction. Okay, so let’s say she can get beyond that, her family is aware of her status, and is supportive of her formula feeding. Now we’re looking at cost. One tin of formula is about 700 Naira. That’s approximately six dollars. If exclusively breastfeeding, she will need to buy about 8 tins a month. That’s 5,600 Naira. Minimum wage in Nigeria is 5,000 Naira, and most people don’t even get that. The challenge here is obvious. The problem has no easy solution. And the children suffer.