I want every baby to come to the world HIV-free
She had no idea she was HIV-positive. She gave birth to a child who contracted the virus while in the womb. PHOTO| AFP
Esther Malalo interrupts her typing to say “hujambo” and “karibu” to patients thronging the Comprehensive Care Clinic, at the Moi County Referral Hospital in Voi.
The widowed mother of two volunteers as a caregiver to other mothers and mothers-to-be. Her white apron competes with a red and white floral skit peeking from just below the knee, as she summons to pregnant women who then follow the nurse in charge to a room with three others. All five women are pregnant and HIV-positive. They are here for a focus group discussion.
Twenty-one years ago, Malalo was in their exact position, but unlike these women she never got specialised services. She had no idea she was HIV-positive. She gave birth to a child who contracted the virus while in the womb.
“The pregnancy was normal. I came for my usual clinics but back then prevention of mother-to-child transmission of HIV was not emphasised as much as it is now. Tests would be done, but mothers were never told their status. I never fell ill and I did not know that other than carrying a baby, I was also carrying the virus,” she says.
Pregnant HIV-positive women can transmit the virus to their babies during pregnancy, childbirth and during breastfeeding.
For this reason, in 2009 the World Health Organisation recommended starting antiretroviral drugs earlier in pregnancies and noted that post-natal ARVs given to the mother or baby are effecting in preventing mother-to-child transmission of HIV.
Updated guidelines included two options, both of which should start earlier in pregnancy, at 14 weeks or as soon as possible thereafter.
Esther, now 40, knows this now.
“I work with mothers who know their status early and are put on ARVs. I follow up to ensure that they continue to take them during breastfeeding. I wish this rigorous campaign was present when I had my firstborn,” she muses.
The child who is now bedridden was diagnosed with the virus at age 10.
“My heart sunk. She was just a baby who had to carry a burden that was not hers.
“However, it has already happened. She is on drugs but falls sick now and again. It gives me joy to see support groups and to keep mothers from going through what I have been through.”
SECOND TIME LUCKY
Malalo was second time lucky. When she was pregnant with her second born, she was put on ARVs as soon as she went to the antenatal clinic, to prevent the transmission of the virus from mother to child.
Taita Taveta County recorded 69 new HIV infections in children aged between zero to 14 years, according to the Kenya HIV County Profiles (2016) report. In 2013, 65 per cent of HIV-positive pregnant women in Taita Taveta did not deliver in a health facility, while only 41 per cent of pregnant women attended the recommended four antenatal visits.
To reverse these trend, the county is conducting sensitisation campaigns to help it eliminate new HIV infections among newborns, as per its HIV and AIDS Strategic Plan that runs from 2016 to 2022.
“We work closely with community health volunteers to reach out to pregnant women in the community. They tell them the importance of HIV testing and attending antenatal clinics. As a county we have made this step to ensure that there are no new HIV infections among newborns,” says acting County Director of Health Eunice Masamo.
Kenya’s guidelines on the prevention of mother-to-child transmission (PMTCT) of HIV/Aids emphasise early initiation of HIV prophylaxis, starting as early as at 14 weeks of pregnancy or earlier depending on the viral load of the mother.
In 2009, when Kenya had a population of 38.6 million, the number of births per annum was 1.55 million, while the HIV prevalence of pregnant mothers was 6.3 per cent and the total number of births to HIV-infected mothers exposed to MTCT was 97,272. Assuming a transmission rate of 40 per cent, and in the absence of any intervention, the number of HIV positive infants per annum would be 38,900.
In February 2017, the ministry of health announced a reduction in new HIV infections among infants.
According to cabinet secretary for health Sicily Kariuki, the number of infants exposed to HIV has dropped from eight per cent in 2013 to 3.7 per cent in 2017, translating to 4,000 new HIV infections averted in infants born to HIV-positive mothers.
She noted that this was the world’s lowest infection rate among countries with a high HIV burden. The remaining four per cent were linked to failure to get proper treatment during pregnancy and birth.
