Baby steps towards a PMTCT programme

Many African countries are struggling to eliminate mother-to-child HIV transmission, a vital component of the universal access to HIV prevention target, but in Somalia a programme to prevent such infections is just getting started.



In 2008, only six Somali women received prevention of mother-to-child HIV transmission (PMTCT) services, although more than 2,600 women were estimated to need them. Not a single health centre delivered the complete PMTCT package which includes HIV counselling and testing, antiretroviral prophylaxis and infant feeding support.



Earlier this year, however, a programme finally got off the ground, with PMTCT services starting to be offered at 21 sites in all three Somali regions - Puntland in the northeast, Somaliland in the northwest and south-central Somalia.



Faisa Abdirashid, HIV officer with UNICEF in Puntland, explained that women who test positive receive psychosocial support and are referred to hospitals where they receive antiretrovirals to prevent transmission as well as advice on infant feeding options.



In addition, UNICEF and its partners are strengthening Somalia's weak health system by renovating health facilities and training health workers.



Progress



The PMTCT programme aims to reach 5,000 pregnant women annually with a comprehensive package, but so far, uptake has been slow.



In the first half of 2010, 1,344 women were tested at the PMTCT sites, 10 of whom tested positive (HIV prevalence in Somalia is comparatively low at 0.7 percent, according to the latest figures from UNAIDS).

I know that a mother can transmit [HIV] to her child, but I don't know how

Abdirashid said although uptake of services is low, it has been increasing every month. In Eldere and Harardhere (in south-central Somalia), for example, the number of pregnant women who accepted HIV counselling and testing nearly doubled during the July to September period compared to previous months. In total, 41 percent of the 2,185 women who came for antenatal visits agreed to be tested.



Challenges



Abdirashid noted that health services remain unavailable in most villages and that most Somali women still have very low awareness of HIV.



“I know that a mother can transmit [HIV] to her child, but I don't know how,” said Hibo Osman, a mother of one from Hargeisa, capital of Somaliland.



According to the latest UN General Assembly Special Session on HIV/AIDS report from Somalia, a knowledge, attitude and practice baseline survey conducted in Puntland’s Mudug region in 2008 found that less than 1 percent of respondents identified PMTCT as an important intervention for preventing HIV transmission to an unborn baby.



According to Abdirashid, stigma is also a major barrier to PMTCT efforts.



“Some of the women who refused the HIV testing did so because they feared the stigma that an HIV-positive diagnosis would bring, especially within their own families,” she said.



Anwar Abdirahman Warsame, executive director of the Sahan Network, a local NGO working in the field of HIV in Somaliland, confirmed that people with HIV are severely discriminated against, often by their own families and communities. “It is very necessary to give more education of the disease and its transmission to the public,” he said.



Efforts to expand the PMTCT programme are also limited by the country’s poor health infrastructure and continuing insecurity in south-central Somalia. In areas that are particularly difficult to work in, UNICEF is partnering with local NGOs to ensure women can access services.



“UNICEF and partners plan to scale up the number of [PMTCT] sites,” said Abdirashid. “Awareness-raising will also be increased - messages are passed on at maternal and child health centres, through radio and other education and communication materials.”



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