Preventing mother-to-child transmission for refugees

In a small, poorly lit classroom in Mtendeli refugee camp, western Tanzania, 20 Burundian and Tanzanian clinicians, midwives and HIV counsellors were on the final day of a three-day training course. They had been discussing HIV/AIDS and antenatal care, practising their counselling skills and learning about the pharmacology of antiretroviral (ARV) drugs. HIV/AIDS is not an issue immediately associated with refugee healthcare. However, it is now emerging as a serious challenge to the refugees. Figures are imprecise, but health workers say that the number of people affected will increase rapidly if the problem is not addressed soon. They say one of the reasons for the spread of the disease is that the refugees, who normally come from a rural background, have undergone a dramatic change in lifestyle. This is why, on 1 April, health organisations working in refugee camps in western Tanzania launched a campaign to prevent mother-to-child transmission (PMTCT) of HIV/AIDS. The project, which aims to build on the success of a pilot project undertaken in refugee camps in the Ngara district of northwest Tanzania, will deliver voluntary counselling and testing to pregnant women and their husbands. Women who are HIV positive will be given ARV drugs to try to prevent their babies being born with the virus, the UN Children's Fund (UNICEF) told PlusNews. "The project was a success in Ngara. More than 90 percent [of pregnant women] took the tests and at least 85 percent of the people found to be [HIV] positive then took ARV drugs," Tesra Masini, a primary healthcare worker for UNICEF, said. The campaign is being funded out of a US $1.5 million grant from the US Bureau for Population, Refugees and Migration, and UNICEF hopes that it will provide vital information on the extent of HIV/AIDS in the refugee camps. To help get the campaign off to a smooth start, organisations working alongside UNICEF on refugee healthcare have spent the past year telling the refugees about the programme. "We have sensitised over 1,000 refugees, religious and youth leaders about PMTCT," Marwa Mtalai, of the Tanzanian Red Cross Society (TRCS), said. "In addition, four Congolese and four Tanzanians have been trained as counsellors and, during the last two weeks, they attended a course on the administration of ARV [drugs]." The TRCS, which runs health facilities in Lugufu 1, a camp for Congolese refugees near Kigoma, western Tanzania, is taking special care to reduce the stigma of going for an HIV test. "All the women go in and pass out through the same door for counselling and testing. Therefore we try to make sure that people have no way of knowing whether someone else is HIV-positive or not," Mtalai told PlusNews. Other agencies have taken similar precautions, introducing coding systems barring the use of patients' names, and building physical barriers to stop other refugees from seeing inside the clinics. But more potential hurdles have already become apparent to the health workers. "In Ngara there was a problem in the very low levels of male involvement," Masini said. "It was less than five percent, so there is a great challenge there. Also there were cases where the husband didn't want the tests to go ahead and this led to cases of domestic violence," she said. Masini said some mothers and fathers in Ngara asked health workers what treatment they would receive if they were found to be HIV-positive. While home-based care is offered to those who are HIV-positive or suffering from AIDS, UNICEF had to explain to them that ARV drugs are only given to women in the 34th week of pregnancy, to be taken as soon as they go into labour, and to babies within 72 hours of being born. AS is the case with all healthcare-related projects in the refugee camps, UNICEF stressed that these services were also being offered to Tanzanians living around the refugee camps and were being integrated into district health plans.