One after the other, the women entered the doctor’s office full of hope and expectation and left with a sense of doom: their pregnancies were confirmed but so was their HIV status – positive. To them it sounded like a death sentence, for themselves and their unborn babies.
No matter how much Mitchell Besser, a gynaecologist who had worked with at-risk pregnant women in California, tried to persuade the women he saw at Groote Schuur Hospital in Cape Town that their status did not spell the end, he could not break through the emotional and psychological barriers wielded by the stigma of HIV.
And then he hit upon an idea – enlist women who were openly living with HIV and were also new mothers to help break down those barriers and educate other pregnant women. With that mothers2mothers (m2m) was born, in 2001.
Gene Falk, an old university friend of Besser’s, joined the group after travelling back and forth to the US, and eventually a six-week stint in Cape Town became “for ever”. His business experience proved invaluable.
"Start-ups are similar in any industry - when you have something unique to offer, and there is a large demand and you need to grow the organization, the issues are not very different ... The lessons are transferable," Falk, the executive director and co-founder of m2m, told IRIN/PlusNews.
"We provide the link between the clinic and medical care: meds alone do not equal medical care if the patient doesn't understand what the drugs are for, how to take them, etc. So we go beyond emotional support and link women to the treatment they need, for their own care and that of the baby's too," he said.
"Knowledge transfer is changing behaviour; we're trying to make medical services more effective. It was Mitch's [Mitchell Besser] experience that we had the tools to prevent mother-to-child transmission, but couldn't implement them because the mothers didn't come back to see the doctor."
|We go beyond emotional support and link women to the treatment they need, for their own care and that of the baby's too|
m2m has blanket coverage in countries like Lesotho and Swaziland, but where medical facilities are far apart and transport is a problem it can be difficult to integrate m2m services with existing healthcare services.
To overcome this, the group taught women to operate and maintain motorbikes, and now the "motorcycle mothers" work in hard-to-reach rural areas.
m2m has on occasion turned away funding if it does not fit in with the group's delivery goals. "The problem is ... sometimes you end up being pushed into expanding when you don't want to, or do not have the capabilities," Falk said.
"We don't necessarily have the expertise to expand into various different services; we're limited to how many countries we cover, and how quickly we can adapt to local needs. We'd rather not take the money until we get up to speed."
Expansion plans are focused on the target group – HIV-positive pregnant women and new mothers. "We reach more than 75 percent of the disease burden in nine countries in sub-Saharan Africa," Falk told IRIN/PlusNews.
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The group employs 1,600 HIV-positive mothers in the field, covering 650 locations with 250,000 "client" encounters, including HIV-negative women and repeat visits by women enrolled in the programme. m2m caters to 20 percent of 1.5 million HIV-positive pregnant women and new mothers worldwide, Falk said.
So far there are no plans to expand to other continents. "The [HIV/AIDS] epidemic is different everywhere. In the race against time, we need to reach more women more quickly. Eventually, we hope to deliver some support to other NGOs, such as technical assistance," he said.
"But we're a small organization with a large field operation, and we're intentionally keeping our overheads way down. At some point we'll provide services to others, but not yet - in the future."
* This article was amended on 17 June 2010
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions