Lucky is not a word usually applied to people living in wind-swept Khayelitsha. Yet this is how Pumeza Bikwe and over a thousand other mothers feel, thanks to a unique health programme that may have saved their babies’ lives.
Eighteen months ago, the provincial health department resolved to offer the anti-retroviral drug AZT to all HIV positive pregnant women in Khayelitsha to try to prevent them from transmitting the virus to their babies.
Most of the women attending the antenatal clinics in Khayelitsha probably would not have taken an HIV test had there not been the incentive of AZT, should they test positive.
As 23-year-old Pumeza Bikwe explains: “When I went to the clinic for my first check-up, the nurse explained that if I went for a test and they found HIV, they could give me pills to help my baby.
“I was very interested in the test because I wanted my baby to be negative. My result was HIV positive and at first I was frustrated. But I have now accepted it and I live normally.”
By the time Bikwe entered the programme, it had already been refined as a result of careful monitoring. Initially, women were given AZT from their 36th week of pregnancy. But after it became clear that HIV positive women tended to deliver their babies earlier, women are now given 300mg of AZT twice a day from their 34th week.
Bikwe also self-administered 300mg of AZT every three hours during labour, instead of having to go to the clinic for the pills once her labour started.
Nurses started giving out pills in advance after finding many women would get to the clinic in advanced labour or even after their babies had been born, yet birth is the time when babies face the greatest risk of getting HIV because of free flow of blood and fluids.
Nine months later, Bikwe’s chubby daughter, Aneliza, has just tested HIV negative Bikwe smiles: “So this mother-to-child transmission programme (MTCT) has been very successful for me. I would really advise other mothers to go for the programme.”
After giving birth, the mothers are advised not to breastfeed as they can transmit the virus via breast milk.
“We give them free infant formula for nine months,” explains Sister Ntuthuzela Ndude of the Site B Day Hospital. Ironically, the formula costs R832 per woman for nine months, while the cost of the drugs is R540.
After giving birth, the mothers face an agonising wait until their babies are nine months old before they are tested for HIV. However, should a baby test positive, it is possible that it may still have some of its mother’s antibodies in its blood. Another test will be done at 18 months old which will finally determine the child’s HIV status.
Without anti-retroviral drugs, babies born to HIV positive mothers stand a one in three chance of getting HIV. With AZT, this risk is cut to one in six.
“It’s very fulfilling to be able to provide AZT, even though at this stage it’s only in one out of the 25 districts,” says Dr Fareed Abdullah, head of health services in the Western Cape.
“In the past 10 years, we have had no success stories in the fight against HIV. I am very encouraged that, for the first time, we are now beating the disease in one small way.”
Dr Eric Goemaere of Medicins sans Frontieres (Doctors without Borders), which is supporting health workers who are running the Khayelitsha MTCT programme, says about 200 babies have been saved so far.
In addition, he says, the programme is also helping to break down the stigma associated with HIV/AIDS.
“Before we started the programme, no one in Khayelitsha would admit that they were HIV positive,” says Goemaere.
“Suddenly, from the women [on the programme] and their partners, we can identify about 2 000 HIV positive people. The numbers are breaking the stigma as the people cannot remain hidden.”
Over 8 000 women have been tested for HIV between January 1999 and July this year. At present, 88% of women booked into the antenatal clinics have agreed to be tested, and this alone has helped to spread knowledge about the disease and how it can be prevented.
Many of the 1 309 women who have tested HIV positive have joined support groups that meet every week. For some, this weekly meeting is a lifeline, says Sister Ndude. Sadly, some have been deserted by partners since they tested HIV positive while others are still grappling with how to break the news to partners and families.
Yet others, like Nomfundo Dubula, have even been inspired to join the Treatment Action Campaign (TAC) and become HIV/AIDS activists.
“At first my test result made me cross because I did nothing to invite this,” said Dubula. “But then I decided to learn as much as possible about HIV/AIDS. I was told about the TAC and contacted their Khayelitsha office.”
Now she is part of a group of young volunteers who run HIV education programmes and campaign for drugs for all people with HIV to slow the progression of the disease.
The Khayelitsha programme has been so successful that the province has decided to extend it to five other areas ‘ Gugulethu, Langa, Bonteheuwel, George and Worcester ‘ next year at a cost of R6-million.
“While we don’t have a proper cost-benefit study, our basic calculations have shown us that, for every R1 we spend in the MTCT programme, we save about R2,50 in hospital costs for treating an HIV positive baby,” says Abdullah. ‘ Health-e News Service.