PMTCT services not reaching rural women

The government's campaign to prevent HIV transmission from mother to child is failing pregnant HIV-positive women in Kenya's remote rural areas.

A shortage of testing sites and trained medical staff in rural areas means many of these women are unaware of their status and that their babies are at risk of contracting the virus.

"You have been blessed with a baby; as part of the Government's free child health care, take your child for HIV testing six weeks after birth," reads a poster at the Isiolo district hospital in Kenya's Eastern Province. "If found positive, your child will receive free care and treatment. Children are a blessing - nurture their health."

These public service messages, strategically placed in government hospitals, are meant to encourage women to use prevention of mother-to-child HIV transmission (PMTCT) services. But the messages and the services they advertise are only useful to women who live close to district hospitals.

"Women attending antenatal care services are never tested for HIV in remote areas of Samburu district [in the northwest]. The services are only available at the district and some few divisional health centres ... many children are contracting the virus from their parents," Margaret Leshore of the local NGO, the Samburu East Women's Empowerment Programme, told IRIN/PlusNews.

"We know that HIV transmission to the unborn can be prevented; transmission while breastfeeding can also be avoided, but we are lacking all these services," she added.

Heavily pregnant Julie Leresh, the mother of four young children, attends the antenatal clinic at Samburu's Lerata dispensary but does not know her HIV status and does not perceive herself or her children to be at risk of infection.

More information and awareness needed

"I have no reason to be tested for HIV. I have heard a lot about it ... I don't stay in town - it affects those who reside in town and it is all because of what they eat and their behaviour," she told IRIN/PlusNews.

Many rural women in the area have views similar to those of Leresh, and health workers have pointed out that unless information about the pandemic is brought to grassroots communities, HIV will continue to spread unchecked. In Samburu, where ignorance about HIV is widespread, prevalence is 6.1 percent, compared to the national average of about 5 percent.

I have no reason to be tested for HIV. I have heard a lot about it ... I don't stay in town it affects those who reside in town and it is all because of what they eat and their behaviour

In areas where services are present, health workers say they should be culturally sensitive if they are to have the intended impact. "Women who are strict Muslims can never allow to be attended by a man," said Ali Boru of the NGO, Isiolo Youth against AIDS and Poverty.

"Also, some of the locals are reluctant to be tested by local health personnel, because some cases of those who were found to be HIV positive are said to have been leaked to the community - it is the worst fear for many."

Boru said the problem was compounded by a severe shortage of qualified medical personnel and counsellors in the region.

The Kenya Red Cross and the government recently drew up a five-year plan to combat the spread of HIV by equipping existing health centres in rural areas with voluntary counselling and testing (VCT) services and using mobile VCT centres.

Dr Robert Ayisi, PMTCT coordinator at the National AIDS and STI (sexually transmitted infections) Control Programme, acknowledged that women in rural areas were worse off.

"We are working hard with our partners in remote areas to ensure that all women, be they rural or urban, have access to PMTCT services," he told IRIN/PlusNews.

According to the government, an estimated 19,000 babies contracted HIV during pregnancy, childbirth or breastfeeding in 2006.

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