Feature - Stigma remains obstacle to HIV treatment

Julia, 24, has three children and is one month pregnant with her fourth baby, but is adamant that she does not want to continue with the pregnancy. "I've got three children already, I'm unemployed, and I am HIV-positive," she told IRIN. Although she and her husband, who is also HIV-positive, were always careful, "the condom burst once", resulting in the pregnancy. Julia took care of her elder sister until she died of an AIDS-related illness last month, leaving behind four children. During this time she was often absent from her job as a domestic worker and was eventually dismissed. She is also nursing her four-year-old HIV-positive son, who is being treated for tuberculosis. Her eldest child is HIV-negative and the youngest, Vanya, is only eight months old and an infant can only be safely declared HIV-negative after testing at 18 months. Vanya is probably negative, because Julia participated in a pilot project to prevent transmission of the HI virus from mother to child (PMTCT) at the Primiero do Maio health centre, in Malhagalene, a suburb of Maputo, the capital. It began in June 2002 and is supported by the international medical NGO, Medecins Sans Frontier (MSF). During her pregnancy with Vanya, Julia was unaware of her HIV status but, like all pregnant women attending the clinic, she was counselled about voluntary HIV testing and the PMTCT project. "I was in good health, but I thought it was better to know," she said. "I was shocked to find out I was HIV positive." She has come to terms with the diagnosis with the assistance of counselling and support from clinic staff. At the onset of labour she was given the antiretroviral (ARV) drug nevirapine and after delivery was counselled on infant feeding. She decided to opt for formula milk, which carries no risk of HIV transmission and is provided under the MSF project. Eunice Queirpoz dos Santos, a nurse at the health centre, told IRIN that Julia was a "model beneficiary". Of the 233 pregnant women who received counselling about voluntary HIV testing at the clinic in August 2003, only 12 opted not to be tested. Thirty of the 45 women who tested HIV-positive joined the PMTCT programme. Although the uptake of pregnant women in the project bodes well for the future expansion of ARV programmes, it is too early to evaluate the results. One of the ongoing challenges is the stigma associated with the virus. Nurse dos Santos points to a box of consultation cards belonging to 28 of the women benefiting from the project. "The women ask me to keep their cards, so that their husbands or other family members do not see their status," she said. The choice of infant feeding is also influenced by stigma. Many women prefer breastfeeding only, because they want to hide their status - they know if they give their baby infant formula, questions will be asked. Discrimination does not stop at the family, and even reaches into the hospital, dos Santos adds. "The women complain that they are treated badly by the midwife when their status is disclosed." When asked how she had coped with the prejudice, Julia said: "Some neighbours would harass me and say, 'that is the one with AIDS'. At first I was a bit beaten down, but now I know life goes on. My main concern now is that I get a job, so I can have money to look after my children."