HEALTH: Nemamwa men show the way

15 Mar, 2015 - 00:03 0 Views
HEALTH: Nemamwa men show the way Sister Revai Baloyi checks Mrs Monica Zuze’s blood pressure while her husband, Mr Chrispen Hove, looks on during an ante-natal care visit at Nemamwa Clinic last week.

The Sunday Mail

Sister Revai Baloyi checks Mrs Monica Zuze’s blood pressure while her husband, Mr Chrispen Hove, looks on during an ante-natal care visit at Nemamwa Clinic last week.

Sister Revai Baloyi checks Mrs Monica Zuze’s blood pressure while her husband, Mr Chrispen Hove, looks on during an ante-natal care visit at Nemamwa Clinic last week.

Since the introduction of the Prevention of Mother to Child Transmission (PMTCT) programme in Zimbabwe in the late 1990s, male involvement has been mainly absent due to some cultural beliefs, leaving most mothers without their partners’ support.

Not so long ago, the perception was that a mother infected with HIV cannot give birth to an HIV-free baby and a mother infected with HIV could not breastfeed her child up to 18 months. As a result of the misconceptions, many children born to parents living with HIV were being exposed to the virus.The simple and plausible answer lies in the PMTCT programme complemented by male involvement as witnessed at Nemamwa Clinic in Masvingo.Nemanwa Clinic, nestled below the monumental Great Zimbabwe, has been recording close to zero HIV-positive babies born from parents living with HIV since 2012 — a remarkable success that some communities are failing to realise. In 2014, out of the 450 pregnant women who got tested for HIV and received their results, 421 male partners followed suit. However, of the women tested, 78 tested positive. Remarkably, only one child out of 56 tested positive. Sister Revai Baloyi, one of the nurses manning the clinic, said delivering an HIV-positive baby is not an option. “With the confidence that we have in ourselves and the support of the community, we haven’t delivered any HIV-positive child since 2012 within our catchment area,” she said.

“If ever we record a case it will be due to the fact that the pregnant mother would have registered with us late in her pregnancy coming from another area.”

Sister Baloyi, however, said that male involvement has helped them achieve these tremendous results. “In this small community being diagnosed with HIV is like being diagnosed with any other disease,” she added. The clinic delivers an average of at least 20 babies per month. At least five of the mothers are HIV-positive.

However, male involvement in other parts of the district remains low. Nyikavanhu Clinic recorded 541 pregnant women who got tested for HIV and received their results with only 169 male partners accompanying them. Mukosi Clinic had 337 pregnant women, accompanied by 63 male partners. Nationwide, male involvement in PMTCT programmes stands at less than 30 percent. According to the national HIV estimates, in 2009 over 30 000 new HIV infections in children were recorded and as of 2014, the new paediatric HIV cases have decreased to 3 587. Couples are a population segment at risk of HIV infection thus male involvement in PMTCT programmes is essential for reducing the risk of HIV infections, both for couples and their unborn children. Mr John and Mrs Spiwe Shava from Village 13B both tested positive in 2013 and their child, Tanyaradzwa, who is now almost two years, is HIV negative.

“When we tested positive with my wife, we didn’t expect to get such results, but we accepted our fate anyway,” said Mr Shava.

“After a series of counselling sessions with the primary care nurse, our goal as a couple was to protect and prevent our unborn child from being infected also. So we did everything that we were told to do by the health workers as measures to protect our child. “Today, we are a happy couple because our child is HIV-free and we wish the same for every child born in Zimbabwe.” HIV can be passed on from a mother to her baby during pregnancy, during delivery or whilst breastfeeding.

Without any intervention, the chances that a baby born to an HIV-positive mother will be infected are 15-30 percent without breastfeeding and 25-45 percent with breastfeeding. With interventions of PMTCT, the chances of mother to child transmission can be reduced to less than 5 percent in developing countries and to less than 2 percent in developed countries. The health ministry estimates that more than 13 percent of the country’s pregnant women are HIV-positive and many have no access to mother-to-child prevention services. When PMTCT was first introduced in the country, it faced resistance in being accepted by the communities due to the high levels of stigma and discrimination.

Traditional leaders have been identified as integral in mobilising, raising awareness and encouraging people in their communities to take up HIV testing. The wake-up call for Nemamwa community was back in 2011 when Chief Charumbira and his wife went for HIV testing publicly. Since then, community leaders make it their business to support the clinic and the health workers by encouraging men to accompany their partners when they receive health care. Village health workers dotted around the community also play an important role in encouraging couples to go for HIV testing together.

Dr Kudzai Masinire, Masvingo provincial maternal and child health officer, commended the clinic.

“Nemamwa Clinic is unique in that they managed not only to achieve but exceed national targets in the PMTCT programme. One cannot compare it to any other clinic in the province because they are doing very well,” he said. “Even though we credit the Ministry of Health and Child Care, more credit is given to the community and traditional leaders who advocated for male involvement in combating HIV.” The PMTCT programme in Zimbabwe began in 2009 by using the World Health Organisation (WHO) guidelines of single dose nevirapine or Option A. In April 2012, WHO released an update on the use of anti-retroviral drugs for treating pregnant women and preventing the spread of the virus to infants. The new guidelines recommended the country to move from Option A to provision of triple ARV drugs to all infected pregnant and breastfeeding women in the ante-natal clinic setting, or continuing the therapy for life regardless of the CD4 count — what is dubbed Option B+. To date it is being initiated at 1 560 health sites. Late pregnancy booking has been cited as the major obstacle in implementing the national PMTCT programme.

According to a recent survey, 90 percent of women aged between 15 and 49 received ante-natal care with only 19 percent of these booking their pregnancies in their first trimester.

Dr Angela Mushavi, the national co-ordinator for PMTCT and Pediatric HIV care and treatment in the Ministry of Health and Child Care, said traditional leaders are a critical stakeholder in the fight against HIV. “Engagement of traditional leaders, especially at a rural set-up where their presence is felt, is essential in ending HIV. Chief Charumbira has led the way and the results are already being felt,” she said.

The failure to target men in health programmes for women and children has weakened the impact of interventions since men can significantly influence their partners’ reproductive health resources.

The Ministry of Health is working towards an ambitious project to eliminate new HIV infections in children by 2015.

The global target aims to reduce new HIV infections in children to less than 5 percent. “As a country, we are on track towards the elimination of pediatric HIV. A recent survey indicated that as of 2014, we stand at 5,3 percent and our national target is less than 5 percent by end of this year,” added Dr Mushavi. However, the Government is still struggling to address the problems caused by mixed feeding where lactating mothers living with HIV mix breastfeeding and other foods instead of adhering to exclusive breastfeeding in the first six months of a child’s life.

With Zimbabwe ranked as one of the 22 countries with the highest burden of pregnant women living with HIV, the Government is committed to the global plan towards the elimination of new HIV infections among children and keeping mothers alive.

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