2017-08-11Staff Report 2 Alvine Kapitako Nyangana-Thirty-eight-year old Bernadette Nkore who lives in Shaghaya village in Nyangana district tested positive for HIV in 2007. “My husband was the one who first tested positive after being hospitalized. When I came to visit my husband I was tested and I was told I am also positive. And then I was put on treatment,” recalled Nkore. In those days being HIV positive was seen as a bad thing, she says. “So I kept my HIV status a secret. I was afraid of what people would say. But today I am open about it. I can openly speak about being HIV positive,” says the soft-spoken Nkore. In the beginning they blamed each other on who might have infected the other. “But the elders sat us down and told us to accept our HIV status and move forward. Now we are living well together,” she says. At the time of their diagnosis, Nkore and her husband only had one child, who is HIV negative. And since they agreed on spending the rest of their lives together, they saw the need to conceive more children. “We planned to have more children so we sought medical attention to assist us to conceive healthy babies.” Eleven years later, Nkore and her husband have four children, three of whom were born after being diagnosed with HIV. The oldest is 17 and the last-born is one year. “When we planned the babies we had to come to the hospital for them to see if our viral load was suppressed and when it was okay we had unprotected sex to conceive, and when we knew that I was pregnant we started using protection again to protect our babies.” Whenever she realised she was pregnant she started antennal care and heeded instructions from health professionals. “I always made sure I delivered in the health facility and breastfed up to six months, and afterwards I stopped completely,” said Nkore, showing two bottles of baby formula. Nkore says part of being HIV positive means staying healthy and adhering to medication to live long. But life has been hard, she adds. “We struggle to make money by cultivating crop fields. Life is not easy for us – even buying baby formula is costly.” Since 2004, the number of children born with HIV has dropped by over 90 percent, thanks to several programmes addressing mother to child transmission of HIV. In fact, since the Prevention-of-Mother-To-Child-Transmission of HIV (PMTCT) programme was started, the HIV transmission from mothers to their children has reduced from 30 percent to less than five percent. Also, the World Health Organisation promotes a comprehensive approach to preventing mother to child transmission of HIV. One important part of this strategy is to provide appropriate treatment, care and support to mothers living with HIV, said US Ambassador to Namibia, Thomas Daughton. In 2015, the Early Infant Diagnosis programme, spearheaded by the US government, has been working together with the Ministry of Health and Social Services to prevent HIV transmission from a mother to her baby. “It is no secret that the highest risk period for HIV-positive infants to die is within the first three months of their life. Therefore, every effort must be made to ensure that children of HIV-positive mothers be diagnosed quickly in order to immediately put them on treatment,” he said. Daughton spoke at the recent celebration of the Early Infant Diagnosis milestone at Nyangana district hospital in the Kavango East Region. Nyangana district hospital reached a 94.4 percent milestone in terms of babies being born HIV-negative, despite being exposed to the virus due to the mother’s HIV-positive status. “Today, 19 out of 20 HIV exposed babies are being tested and referred to treatment and care if needed,” a proud Daughton remarked. Sharing on the success story of Nyangana district hospital, Rightwell Zulu, a nurse mentor at the hospital, explained that Nyangana is a shining example in the prevention of mother to child transmission of HIV because they have put in place a system to record all births at the hospital in a register. The system also tracks down mothers and their infants to make sure they get tested and are taking the medication correctly, Zulu explained. The register was put in place because the biggest challenge was that there was no system in place to know how many babies have been exposed and tested for HIV. “We are tracking babies from the time they are born until the baby is (HIV) negative,” said Zulu. “When we implemented the system to track down all babies and make sure that they are tested, our performance went up to 94.4 percent.” He also explained that every HIV-positive mother is monitored from the time they start antenatal care until the baby stops taking breast milk. Upon discharge from the hospital, the mothers go through counselling on the importance of ARVs, exclusive breastfeeding and why the baby should be tested at six weeks for HIV. “Our target is that the baby should at least be tested at eight weeks if there is a delay at six weeks,” stated Zulu, who explained that sometimes there is a challenge of mothers not being close to the health facilities, within the district. “People stay far,” he added. “But very few babies test positive,” said Zulu. In most cases, it is babies of mothers who deliver at home who tend to be HIV positive because there was no medical care. Women who choose to deliver at hospitals have so far not refused to be tested for HIV. As a result, those who test positive are immediately put on treatment in order to suppress the viral load and thus reduce the chances of transmitting the virus to the baby. The nurses are trained to test children for HIV. “We allow the child to go on prophylaxis (doses of antiretroviral drugs to prevent contracting HIV),” he said. Prophylaxis is treatment given or action taken to prevent disease and in this case HIV. “In the case of positive mothers we check through her health passport to check for her viral load and if the viral load is known, we know that the chances of being infected are less.” Registered nurse Simunda Kalu said that since the new system was implemented last year no HIV-positive babies were born at the hospital. A baby born to an HIV-positive mother is put on treatment (prophylaxis) immediately after birth, she said. “It’s a must,” stressed Kalu. The babies are classified low risk to high risk, depending on whether the mother choses to breastfeed her baby and for how long. “Babies who are low risk are given a syrup prophylaxis and the high risk babies are given nevirapine,” adds Kalu. And, in the case where a baby is HIV-positive after prophylaxis, they are put on antiretroviral therapy. Meanwhile, Nkore is grateful that people living with HIV do not have to pay for their medicines. “Sometimes I think whether I will get this medicine for the rest of my life or will the government one day say they don’t have money to provide free ARVs. I don’t think of a cure because I will take the medication till death,” Nkore said. The Early Infant Diagnosis programme is funded by the US President’s Emergency Plan For Aids Relief (PEPFAR) and implemented by Intrahealth International, in collaboration with the Ministry of Health and Social Services. 2017-08-11Staff Report 2
