Clinic shows way in preventing mother-to-child transmission

When the father of Fasika Lemma's daughter died seven years ago, she decided to get tested for HIV; the results revealed she was indeed HIV-positive, but worse was to come.

"A year after, I learned it could be transmitted to my daughter through breastfeeding," Fasika told IRIN/PlusNews. "I decided to have her tested."

Babies born to HIV-positive mothers and non-exclusively breastfed have a 25-40 percent chance of contracting the virus, according to the UN World Health Organization.

Fasika’s daughter was one of the unlucky ones. "I felt it so deep," she said.

Anti-retroviral treatment during pregnancy and after a baby's birth can lower the risk of mother-to-child transmission to below 5 percent, but in Ethiopia, one of Africa's poorest and least urbanized countries, fewer than one in 15 pregnant women with HIV has access to the treatment.

Fasika, now 30, is trying to help raise that figure. She has become a volunteer at a clinic run by the health department in the capital, Addis Ababa. The clinic, on the northern outskirts, in a neighbourhood known as Addis Ketema, or New City, is at the forefront of Ethiopia's HIV/AIDS epidemic, in part through funding from the UN Children's Fund.

Outside the mud track at the clinic's gates, donkeys carrying loads of firewood dodge overloaded minibus taxis carrying day-labourers to work in the nearby Mercato market. Men urinate into open gutters and small groups of homeless boys lie sleeping together at the roadside. With one doctor, two clinical officers and two dozen nurses, the clinic serves an area housing 150,000 people.

"This is a slum," says Biniyamin Woldeamlak, the director. "The city's biggest bus station is here and there is much prostitution because most of the women don't have jobs."

Fighting stereotypes

Fasika's job is perhaps the most difficult. About 4 percent of the pregnant women who come into the clinic test positive for HIV/AIDS; it's her job to inform them of their status and counsel them.

"I start by telling them about myself," she said. "They don't believe me because there is a stereotype that people with HIV are very skinny and their skin is spotted and they have light hair."

After revealing the test results, she counsels them to tell their partners and to enrol in her support group, which meets five times a week at the clinic; many fear their husbands or partners will leave them.

There is a stereotype that people with HIV are very skinny and they have light hair

Boyfriends and husbands rarely show up to get tested, says Woinshet Gebremarkos, a nurse. The women at the clinic, however, almost always agree to take ARVs when they realize they can save their baby from contracting the virus.

When the women are seven months pregnant, they begin treatment. Just before they deliver, they are given another dose of ARVs. Each baby is then given ARV treatment for the first week of life, and the mother is counselled to feed them formula if she can afford it. If not, they receive information about exclusive breastfeeding, which can also reduce the risk of transmission, as mixing feeds with formula can compromise immunity.

Although they live in a slum, the HIV infected mothers-to-be of Addis Ketema are still luckier than most in Ethiopia. Even in Addis, just six of the 24 clinics run by the city offer the treatment to pregnant women. In rural areas, where almost all women give birth at home, it is virtually unknown.

Ethiopia had more than 75,000 HIV-positive pregnant women last year, according to government estimates. Only about 5,000 received treatment to prevent mother-to-child transmission.

Six weeks after birth, mother and baby return to the clinic, and the mothers are encouraged to have the babies tested. Of the 124 HIV-positive women treated over the past year, 119 babies tested negative.

"The happiest moment for me is when a child comes back 45 days after delivery and tests negative," Fasika said.

jm/kr/mw