No more long anxious waits
Last year, Isabel, a mother of six, had been prepared for another long, anxious wait to find out the HIV status of her baby, Tomas. She remembers how, in 2007, it took three months for her second child’s HIV test result to be sent to her local clinic. “I kept going to the clinic only to be told they had not received the test result,” says Isabel. (The names of the mother and baby have been changed to protect their privacy).
Despite having to make many trips to the clinic, Isabel persisted. She had already lost a son at the age of 3 months in 2004 before he was tested for HIV. Last year, however, was a different story, thanks to the recently introduced Point of Care technology which undertakes HIV tests for infants under 18 months. The nurse was able to test the blood from Tomas when he was only 1 month old and told Isabel that she would receive the result on the same day. “I was so surprised when the nurse told me to sit down and wait for the results,” says Isabel. “I was scared about the result, but at least I didn’t have to wait long to find out he was HIV negative. I was so relieved.”
Six months later, Isabel brings Tomas to be weighed at the Ponto Gea Health Centre in Beira city where she sits with a crowd of mothers and their babies, many breastfeeding, who are waiting outside the consulting room in a sheltered open space. Some of the mothers have brought their babies for an HIV test and others for growth monitoring.
Rosy Manuel, 14, and Marcel Junior, 16, discuss issues they feel strongly about. They both mention how girls are more vulnerable to HIV, how discrimination against people living with HIV is still a challenge, and how fathers should be more involved in bringing up their children.
, “I think girls who don’t go to school or who drop out of school are particularly vulnerable as they are out there alone and are susceptible to all kinds of bad treatment” — Rosy, 14.
One at a time, they enter the cramped consulting room, yet the nurses handle the point-of-care machine with ease. It looks like a desktop printer, and can deliver a test result for HIV in just 50 minutes.
Nurse Josefa Menezes is one of its main users. Last year, she took part in a two-day UNICEF-supported training, after which, she says, she finds the machine easy to use. She is excited when she explains how, since they began to use the point-of-care machine in July 2016, their work has become much easier. “Before, we had to send the tests away; and we would have to keep telling mothers that we hadn’t received the results and that they needed to come back again another day. There was a time it took up to three months, then we lost track of some of the mothers and their babies. Some would move to different areas, some did not register with the clinic, and we did not even know if the babies were still alive.”
"We need to scale up testing with the point-of-care machines throughout the country” - Dr. Dezi Mahotas, UNICEF.
Dr. Dezi Mahotas, UNICEF health specialist, highlights that the point-of-care machine has other benefits too. “Many children’s lives have been saved as if they do test positive, we are able to put them on treatment straightaway, whereas before they would often only get treated once they had developed HIV-related illnesses and by then it was often too late. Now we need to scale up testing with the point-of-care machines throughout the country.”
On average, at the Ponte Gea Health Centre, about 50 babies delivered by HIV positive mothers are being tested every month, and of those, around five babies are testing HIV positive. “We are not satisfied with this result,” says nurse Menezes. “I will only be happy when all our babies test HIV negative.” One of the biggest challenges, she adds, is the lack of involvement of fathers. “Women are scared that their partners will abandon them, or talk badly about them in the community and discriminate against them, so some just hide their status and take their tablets in secret.”
Marcel is a child radio producer at the local radio station in Beira city, in the central province of Sofala, Mozambique. His dream is to be a pilot but is still at school. In his spare time he works as a child radio producer covering issues related to child rights, including sexual and reproductive health.
“Fathers are less involved in childcare as they work outside the home and some think that childcare is women’s work. But this should not be the case as it is important for a father to be involved too; he needs to spend time communicating with his children” — Marcel, 14.
The views of Marcel and Rosy are pertinent. Lack of paternal involvement at the local mother and child clinic is one of the main obstacles in the prevention of mother-to-child transmission (PMTCT) of HIV for the nurses at the antenatal and postnatal clinics. Many women living with HIV still fear they will be discriminated against and abandoned by their partners, and some do not even reveal their HIV positive status to their partners. Yet this is slowly changing and, in the last year, significant advances in HIV prevention, diagnosis and treatment of newborns have been made.
Menezes adds that although stigma around HIV has reduced dramatically, it still exists. “Some mothers prefer to go to another health centre to receive the medication as they are scared that someone they know will see them.” She also states that during regular group discussions with HIV-positive mothers, HIV stigma and cases of discrimination always comes up. “I always tell the mothers that whatever they discuss in the groups should remain in the group, and that they must not disclose outside.” At the antenatal clinic nurse Inez German confirms that lack of paternal involvement is a problem. She explains that besides the usual counselling messages for HIV-positive pregnant women – to adhere to antiretroviral (ARV) treatment, to deliver in a hospital, and to exclusively breastfeed for the first six months – healthcare workers also stress that women should bring their partners for HIV testing. But she estimates that about 1 in every 5 partners of HIV-positive women either do not know about their partner’s HIV positive diagnosis or are not supportive. “Some even beat their wives and throw them out of the house. We need to improve our counselling and get more men involved,” she says.
“I want to keep healthy to look after my children, so they can study,” - Isabel, HIV positive mother.
Nurse German points out that the health centre is making efforts to involve men. For example, at the antenatal clinic, a pregnant woman who comes with her partner will be attended first, and the clinic also counsel men about the importance of the test.
"I estimate that 1 in 5 partners of HIV-positive women either do not know about their partner’s HIV positive diagnosis or are not supportive.Some even beat their wives and throw them out of the house. We need to improve our counselling and get more men involved,” — Nurse German.
Meanwhile Isabel, who is preparing to make the 10-kilometre journey home on public transport, says her husband, who tested HIV negative at the clinic, is supportive. Despite this, she prefers to be treated in this health centre rather than at her local health clinic. She also does not disclose her HIV positive status to friends; her mother, a single parent, died when she was young.
Yet, she says, she is thankful for the support at the health clinic. All her children are HIV negative, and she has kept healthy, managing to adhere to her antiretroviral medication. Moreover, despite long hours at a market selling fish, Isabel, who does not know her age, has also enrolled in adult education and at lunch time, is studying the equivalent of Grade 1 primary school. Yet her dream for the future is more about surviving for her children’s sake. “I want to keep healthy to look after my children, so they can study,” she says, kissing her baby on his forehead.