Anteretrovirals are lifesavers but HIV stigma remains

Cradling her newborn son in her arms, Gifty Mensah shows him off proudly to family members and friends but her joy is clouded by a secret she dares not share: she is HIV positive.

Gifty, who is 26, was shocked to discover her status when she took a test during a regular antenatal visit last year.

“I didn’t believe it at first. I just cried,” said Gifty, a market trader in Accra, whose real name has been used here to protect her identity.

Yet the test proved a lifesaver for both she and her son. She started taking anteretrovirals immediately and when her son was born in March he tested negative for HIV.

A campaign by the Ghana Government, the United Nations and its partners to reduce mother-to-child transmission of HIV is bearing fruit. Anteretroviral drugs are more available and mothers are encouraged to take an HIV test early in pregnancy.

As a result, there was a 31 per cent drop in the number of pregnant women passing HIV to their children between 2009 and 2012. The reduction has been singled out as an African success story.

At the same time, the percentage of women who tested for HIV and received counselling rose from 39 per cent to 71 per cent, according to data from the National AIDS Control Programme (NACP).

Under an ambitious global plan, Ghana hopes to eliminate transmission of the HIV virus from expectant mothers carrying the virus to their children by 2015. Gifty is just one of those success stories.

Although stigma about HIV and AIDS remains a huge stumbling block, many people who could benefit from anteretroviral treatment refuse to get tested.

When people fail to disclose their HIV status to their partners it exposes them to increased risk. In addition, they lose the advantage they could get from beginning anteretroviral treatment early after being exposed, according to health experts.

While Gifty told her husband she was pregnant, she initially concealed her HIV status from him. She says that at first she would hide in the bathroom to take her daily doses of anteretroviral drugs. But a few weeks before her due date the strain became too great.

“Instead of being happy about the baby, I kept on crying and crying so he insisted on accompanying me for my last check-up. He said he knew something was up,” said Gifty.

At the clinic, Gifty’s husband learned the truth. He agreed to get himself tested and  the result came back as HIV positive. The couple decided to keep the secret to themselves because they feared the reaction of their families. Even Gifty’s mother was not told when she attended the birth of her second grandson.

Gifty’s newborn infant tested negative for HIV, something she is delighted about. But when she thinks of her family who have been kept in the dark about her status, a haunted look comes into her eyes and she concludes, “We can’t tell them. They won’t be able to take it,” she said.

Antenatal clinics hold the key

Many women in Ghana discover their HIV status during routine pregnancy checks at antenatal clinics. Gifty said the care and support by the nursing staff who disclosed the news to her helped her bear the shock.

“The nursing sister counseled me. She was so kind. She helped me cope,” Gifty said.

Antenatal clinics are at the heart of the campaign for the Prevention of Mother to Child Transmission – the global plan launched by UNAIDS and its partners to eliminate new HIV infections among children by 2015 and to keep their mothers alive.

While HIV prevalence among the general population in Ghana is relatively low at 1.5 per cent,  that among pregnant women is 2.1 per cent, echoing the disproportionate way in which the disease affects women across the continent.

African women make up nearly 60 per cent of adults living with HIV, according to UNAIDS data. In addition, about 900 children in low and middle income countries become infected daily.

Anteretroviral therapy given during pregnancy can reduce mother-to-child transmission to less than five per cent and maintain a mother’s health. It also helps prevent a woman from infecting her partner. Without the drugs the percentage chance of infecting a baby goes up to forty per cent or more.

Gifty receives her anteretroviral treatment at the Korle Bu Hospital’s Fevers Unit  – a  leading Centre for anteretroviral treatment in the country. “Recent results for newborn babies born to seropositive mothers treated there confirmed the success of the Unit’s Prevention Of Transmission From Mother To Child drive”, said Dr. Ernest Kenu, a Physician.

Out of 63 infants screened for exposure to the HIV virus between January to December 2012 at the Unit, only three were found to be seropositive, Dr Kenu added. The mothers of those three had not been diagnosed until very late in their pregnancies and so had not received anteretroviral therapy, according to Dr Kenu who remarked, “These are amazing results.”

Option B+

One method of treating pregnant mothers living with HIV is the Option B+,  which puts them on antiretroviral drugs for a lifetime.

Option B+ has already been adopted successfully in African countries like Malawi and Rwanda. It offers all pregnant or breastfeeding women who are HIV positive a lifetime on anteretroviral drugs to protect their own health and that of future pregnancies. It also brings down the chances of transmitting the virus to a sexual partner to nearly zero.

Ghana has not yet fully adopted Option B+ but instead follows ‘Plan B’ which treats expectant mothers living with HIV with a combination of anteretrovirals throughout pregnancy, during labor and delivery up until a month after they stop breastfeeding, according to the NACP. Gifty is being treated with the Plan B system.

Initial trials of the Option B+ plan in Ghana last year had hiccups mainly due to the limited capacity for specialized lab testing that the option relies on and a shortfall in funding, Dr. Nii Akwei Addo who heads the NACP said.

“Our national target is to see 90 per cent of all pregnant women in Ghana tested and given follow up counselling and anteretroviral therapy if needed”, Dr Addo said, adding that the current coverage of pregnant women is around 70 per cent.

One major concern is about the women who don’t attend antenatal or don’t return to a referral clinic for follow up if they are found to be HIV positive.

A shortfall in funds for financing the mother to child prevention drive could also seriously affect its efficacy and allow expectant women to fall through the cracks, he said.

Stigma, The last bastion

For Gifty, the fear of stigma outweighed the knowledge she gained about the safety of having a baby while living with HIV. A few days before she was due she travelled miles away from Accra where she lived and worked, to her birthplace in the Central Region, where no one knew her “secret “ and gave birth to her son at home.

“It was simple,” she said. “I couldn’t have afforded a Caesarean -Section anyway,” she added.

Stigma about HIV and AIDS is still very prevalent in Ghana and remains “the last bastion” hindering progress against the control of the disease, said Girmay Haile, UNAIDS Country Coordinator for Ghana.

It is not uncommon for people in Gifty’s position to travel miles away to the next Region or town for treatment  to prevent their families from knowing their status.

For now Gifty is back trading in the market as well as bringing up her baby, who is thriving. He will repeat the HIV test when he is six months old. Hopefully, the results will confirm his current status.

“I have a normal life. I didn’t think I could make it,” Gifty said, reflecting on how the HIV diagnosis has changed her life. “But I wish I could tell my big brother,”  she sighed.

By Yaa Oforiwah Asare-Peasah & Amba Mpoke-Bigg
Source: GNA