writes Richard Newsome
Africa-Press – Uganda. By targeting specific points in pregnancy and childbirth, doctors can mitigate the transmission of HIV or manage its effects.
HIV looms large in Mozambique. Public messaging about condom use, HIV testing, and other HIV-healthy behaviours like voluntary male circumcision are commonplace around the streets of Maputo, and across the country. People in Mozambique understand that the magnitude of the problem of HIV is greater than any taboo.
Bold interventions are needed to limit the spread of the disease, involving whole-of-society efforts. Ambitious public health efforts, including health messaging, testing and treatment programs, have already been successful. Today, 87 per cent of Mozambicans living with HIV know their status. That is up from only 62 per cent in 2015.
Despite these successes, one group that is too often forgotten in discussions about HIV is children. According to UNAIDS, while 84 per cent of HIV-positive adults in Mozambique are on antiretroviral drugs that suppress the virus, only 55 per cent of HIV-positive children under 14 are. And this group isn’t small; 180,000 Mozambican children aged 14 or younger live with HIV, more than in any other country globally. Childhood HIV is specifically challenging as the wasting and stunting associated with undertreated AIDS have significant impacts on a child’s development, impacting their success in school, and further weakening their immune system against other illnesses for their lifetime.
Most HIV infections for children under 14 occur through mother-to-child transmission, typically during pregnancy, childbirth, or through breastfeeding. Taking advantage of existing testing and treatment programs at these three moments can improve the lives of so many young Mozambicans at minimal cost.
Pregnancy
During pregnancy, 94 per cent of women in Mozambique attend at least one doctors visit. This gives doctors a consistent moment of insight into women’s health. During prenatal visits, doctor-initiated HIV testing should occur regularly. HIV-positive mothers have a near 40 per cent chance of passing HIV onto their child if no steps to avoid transmission are taken. Those odds drop below 2 per cent when risks are properly mitigated through medication and appropriate care during childbirth, such as antiretroviral therapies and giving birth by c-section.
Testing is the first step in setting up a plan to give a child the best chances of being born free of HIV. While doctor-initiated testing is, ostensibly, the norm in Mozambique, only 75 per cent of mothers receive HIV-testing during prenatal visits, while vulnerable women–those whose children are most at risk of childhood HIV and poverty–are those least likely to receive testing. This number should be much higher if we hope to best meet the needs of future generations of Mozambicans.
In neighbouring South Africa, a similarly under-implemented provider-initiated HIV testing program for prenatal visits exists. A survey among South African doctors showed that the primary reason that pregnant women are not being tested for HIV is that doctors fear women will assume pressure to test comes from a presumption on the doctor’s part that she is HIV-positive. If the same is true in Mozambique, the path forward cannot be inaction and deference to taboo, as norms and expectations can only be changed if doctors act consistently, such that women understand that they are not being singled out by a doctor initiating HIV testing.
Childbirth
Childbirth also offers doctors an opportune moment for testing and care. Approximately 65 per cent of Mozambican mothers give birth in a medical facility. For mothers who are known to be HIV-positive, c-section births can help reduce the risk of transmission. Testing children’s HIV statuses during their first few days of life can afford doctors and mothers an early opportunity to establish a plan for caring for HIV-positive children, ensuring their healthy development. Nutritional support and appropriate medication have been shown to benefit childhood development broadly but have an even greater effect among HIV-positive children.
Sending mothers home after childbirth with the resources they need to care for their child, whether that be the life-saving antiretroviral medication or other forms of social assistance, can ensure that HIV-positive children’s management of their condition starts early, that those who need assistance are receiving it, and that healthy habits are started early.
Early development
While early childhood doesn’t have the same natural points of intervention, such as prenatal medical visits or childbirth, the risk of a child contracting HIV persists after birth. Breastfeeding can induce mother-to-child transmission of HIV, meaning continued monitoring of a child’s HIV status after birth is essential.
HIV-healthy behaviours, such as not permitting other women to breastfeed your child, should be stressed at earlier stages, such as during prenatal visits. For HIV-positive children, nutritional and medical support are of the utmost importance. HIV-induced wasting, while serious for all individuals, can have lifelong and irreversible effects for children. Including all HIV-positive children in nutritional support programs, such as the country’s Child Grant Program, can make a massive difference.
What’s next
While externally funded programs like the United States’ President’s Emergency Plan for AIDS Relief have been incredibly impactful, recent changes in the donor-led development sector have highlighted the value in effective domestic programs. Operationalising existing but underutilised programs, such as provider-initiated HIV testing and zero-cost antiretroviral therapies or expanding programs like the Child Grant Program to HIV-positive children, can seriously improve the lives of many, largely using existing resources. HIV care has the power to reach everybody. Let’s make sure nobody, whether young or old, is left behind.
LSE
