Poverty threatens efforts to stop mother-to-child HIV transmission

Preventing HIV-positive mothers from infecting their children remains a serious challenge in conservative and impoverished Ethiopia, where women are expected to breastfeed their babies. Prevention of mother-to-child transmission (PMTCT) programmes advise mothers to find replacements for breast milk in order to reduce the risk of passing on the HI virus to their children through breastfeeding. However, in a country like Ethiopia, parts of which suffer from chronic food shortages, alternative food sources are often unavailable. Amelework Tesema, a 38-year-old HIV-positive mother receiving treatment at Zewditu hospital in the Ethiopian capital, Addis Ababa, said she found it extremely difficult to feed her baby girl. "When I first came to the hospital, the doctors convinced me to start the treatment," she said. "I have accepted their advice and started to use the treatment, but getting replacement foods for my kid is a headache. I can't feed my baby properly and she is losing weight. I am confused about what I should do." According to a recent study by the United Nations Children's Fund (UNICEF), about 15 to 20 percent of infant HIV infections occur during pregnancy, 50 percent during labour and delivery, while breastfeeding accounts for a further 10 to 30 percent. Preventing transmission during pregnancy and birth involves both mother and child taking antiretroviral drugs, but stopping infection through breastfeeding means resorting to formula milk and other breast milk substitutes, an option not open to most Ethiopian mothers. "Many mothers in developing countries cannot afford breast milk substitutes and lack access to clean water, which is essential for their safe preparation and use," said Dr Yohannes Leulseged, head of PMTCT services at Zewditu hospital. For many of these mothers, not breastfeeding often leads to malnutrition and death of the child. "These problems are aggravating the death of children due to HIV/AIDS. Adequate care and support - including nutrition - should be made available to tackle these problems," Amelework said. "Otherwise, PMTCT treatment has its own disadvantage to positive mothers." AIDS activists have also pointed out that HIV-positive mothers need to be educated to take better care of their own health so they can be in good enough health to look after their children. "HIV positive women who decide to have babies are facing various problems. They only focus on their children and forget to look after themselves," said Anteneh Tsige, who works with Dawn of Hope, a local NGO of people living with HIV/AIDS. In addition, many Ethiopian women fear the consequences of refusing to breastfeed their children, which is considered an important part of their culture. "Breastfeeding is a critical issue in the Ethiopian culture, because a woman is expected to breastfeed her baby," said Zewditu's Yohannes. "Infants not infected during pregnancy and childbirth whose mothers are HIV positive face a 10 to 15 percent chance of acquiring HIV through breastfeeding, depending on how long they receive it [the milk]," he added. "Throughout [the country], the treatment has multicultural problems, and PMTCT should be supported with proper care and support." Yohannes said in order to encourage HIV-positive mothers to start the treatment, the hospital was providing education on prevention to pregnant women. The Global Fund to Fight AIDS, Tuberculosis and Malaria, United States President George Bush's Emergency Plan for AIDS Relief, the UN and various NGOs have partnered with the government to ensure that more pregnant women around Ethiopia are receiving PMTCT services. UNICEF is currently undertaking PMTCT programmes in the Ethiopian towns of Dilla, Dire Dawa, Gondar and Jimma. The UN World Food Programme is also involved in feeding pregnant mothers and their children under the age of two attending PMTCT programmes in six Ethiopian cities. At the state-run Zewditu hospital, programmes for the prevention of mother-to-child transmission of HIV began in 2003. Similar programmes are also being carried out at three other hospitals in the city, according to Yohannes. The government, he said, was providing PMTCT to more than 2,000 women around the country. "So far, over 600 mothers and children are receiving the treatment being given freely in the hospitals in the city," Yohannes said, noting that another 150 mothers and children were also receiving the treatment in hospitals around Addis, home to some five million people.