Poverty affecting ART use among mothers

Poverty is preventing many Ugandan mothers from using drugs that prevent mother-to-child transmission of HIV, and this has put more children at risk, health researchers said. "It is frustrating when these mothers come for a single dose of Nevirapine to protect their unborn babies, but when they are discharged and told to report back, they don't," Phillipa Musoke, head of the paediatrics department of Uganda's Makerere University medical school, told PlusNews. "Many will tell you they did not have resources like transport to come back," she said. The fact that many HIV-positive mothers cannot afford alternatives to breast-feeding, was also affecting strategies to protect their children from contracting the disease, Musoke added. "We have recommended to these HIV-positive mothers that they should not breast-feed their babies, but they find themselves at a crossroads," she noted. "They cannot afford the alternative foods which are very expensive or cows milk." Musoke is part of a team of researchers on a programme being conducted by Makerere University and Johns Hopkins University, which is assessing the success of antiretroviral therapy (ART) in preventing mother-to-child HIV transmission. Musoke said that a baby's risk of contracting HIV through breast-feeding was between 14-29 percent. She highlighted the fact that while the risks of infection from breast-feeding were relatively low in the first three months, underprivileged children who did not breast-feed recorded higher incidences of acute diarrhoea and malnutrition, often leading to death. "We have recommended that they breast feed for three months and then stop, because it is not worth preventing babies from becoming infected at birth only for them to die after birth from not being breastfed," Musoke told PlusNews. The joint Makerere-John Hopkins programme started in 2000 at Mulago Hospital, Uganda's main referral hospital, and has since attended to more than 90,000 mothers. Musoke stressed that the challenge was to ensure that the 70 percent of HIV-negative babies born to HIV-positive mothers maintained their negative status. "At least US $300,000 will be needed every year to keep tabs on these clients to provide intensive follow-up, provide the necessary care to mothers, and also carry out the normal immunization of the babies," she noted. Musoke noted that stigma had also affected the use of the drugs. Mothers who were advised not to breast-feed, for example, often continued to do so out of fear of disclosing their status, while male involvement remained limited, with only 1 percent of women who tested positive bringing their partners to get tested. According to the researcher, a single dose of Nevirapine given to an HIV-positive pregnant woman just before labour, and a few drops administered to the newborn in the first 72 hours, halves the risk of HIV transmission. Nevirapine is also used in combination with other drugs to prolong the lives of people living with HIV/AIDS. The manager of Uganda's AIDS control programme, Elizabeth Madra, recently announced that about 13,000 women who gave birth in Uganda last year received Nevirapine, or a combination of AZT and 3PC, before delivering of their babies. The programme, however, hit a snag when questions were raised about the research methods used to collect and analyse the data of a US-funded study in Uganda on Nevirapine. Every district hospital in Uganda offers the service, but officials say the infrastructure remains very limited and high poverty levels continue to impede progress. Uganda has won praise for its success in the fight against HIV/AIDS, which has seen prevalence rates drop from over 20 percent in the 1990s to under six percent in 2004.