Keeping up appearances can cost babies their lives

"I knew the danger I was putting my child through but I did not want to arouse any suspicion and I complied with my husband and his mother's demands," said HIV-positive Eunice Omulo, 33, who lives in Maseno, western Kenya. Against the advice of the hospital, she bowed to family pressure to give her baby solid food at just three months of age.



Omulo discovered she was HIV-positive during an antenatal visit before the birth of her fifth child. She was given medication to prevent mother-to-child transmission (PMTCT) and had her baby at the hospital; then she went home. "When I tested positive, I feared telling my husband or even my mother-in-law because I didn't know what they might do to me," Omulo told IRIN/PlusNews.



"They started putting pressure on me to start giving my child other foods at only three months, as tradition demands, and there was nothing I could do ... I feared telling them why the child could only take my breast milk, so I started feeding him on mashed potatoes and porridge."



The UN World Health Organization recommends that HIV-positive mothers exclusively breastfeed their children for the first six months of life to improve their chances of survival in cases where replacement feeding is unacceptable and unaffordable. Several studies have shown that stopping breastfeeding early is associated with a higher risk of infant mortality in HIV-exposed children.



"When I took the child to the hospital for a second test after some months, he tested [HIV] positive but I kept lying that I had been following the instructions given to me by the nurses."



Elizabeth Achola, coordinator of the PMTCT programme at Maseno Mission Hospital, said denial and failure to disclose status to spouses and relatives were some of the main challenges to the hospital's efforts to keep children HIV-free.



"Most mothers who come here for antenatal visits are very reluctant to disclose their status to their husbands," she said. "In fact, most would rather come with other relatives than their husbands." When the nurses asked Omulo to bring a relative to her counselling sessions, she brought her sister, who has kept her secret.



"Those who choose formula feeding are forced to breastfeed when they get home, and those who choose exclusive breastfeeding are forced to wean their children when it is still dangerous for them to do so," Achola said. Counselling was difficult because few women admitted they were flouting proper feeding practices.



Cultural infant feeding practices and the fear of being stigmatized meant that many women would rather risk infecting their children than deal with the fallout from the possible discovery of their HIV status.



Community education was the key to eradicating stigma and creating a safe environment for women to protect their children from the virus. "If not tackled, [incorrect infant feeding] could erode the gains already made in preventing transmission amongst infants, especially in rural areas, where traditional beliefs and stigma still hold sway," said Achola.



The Maseno University AIDS Control Unit and the Maseno Mission Hospital have now created a club where HIV-positive mothers can meet, share their experiences and support each other's efforts to keep their children HIV-negative.



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