Pregnant women resist HIV screening

HARARE - “If only I had the courage to be tested for HIV, my child would have been born negative,” Maud Chifamba from Wedza says ruefully.

Twice, Maud visited the local clinic seeking ante-natal services, but retreated each time she was lined up for HIV testing.

Today, she is nursing a home-delivered HIV-positive infant.

Full of regret, Chifamba says, “I was strong. I did not understand why the nurses wanted me to get that test so much. I was afraid.”

Many pregnant mothers, because of fear, are delivering at home as health institutions make HIV counselling and testing a prerequisite.

The National Aids Council estimates that Zimbabwe has about 64 000 mothers in need of Elimination of Mother to Child Transmission (eMTCT) services while Unicef estimates that 200 000 children are living with HIV in the country as of 2011.

Health experts believe the country has witnessed an increasing trend in home deliveries since 1999, in the context of a weakened health delivery system, economic hardships and cultural barriers.

From 2006 to 2009, according to the Multiple Indicator Monitoring Survey, home deliveries rose by eight percent to 39 percent.

Drawing from the research findings, health experts feel mandatory HIV testing for all pregnant mothers is the best way forward in eliminating mother-to-child HIV transmission.

Though chapter four, section 76, of the country’s six months old Constitution guarantees the right to health, it does not criminalise any citizen who chooses otherwise.

“Our greatest challenge is this song called human rights being sung every time but why do we need them if they kill an innocent child?” said Wedza village head Simon Musanhu, whose court has taken to meting out punishment in the form of fines for home deliveries, a development deemed by critics as unconstitutional.

Angela Mushavi, eMTCT director in the ministry of Health,  believes comprehensive knowledge transfer to pregnant mothers is the only available option at the moment to improve the situation.

“The Constitution demands that everyone should be given free consent,” Mushavi said.

“We cannot force people because we would have diverged and breached their constitutional right. Sometimes people shun testing because they do not fully understand. I believe if we teach each other then go to clinics and be served by true professionals who respect us, no one will say no. No one wants their children to be HIV positive.”

According to Unicef, an estimated 860 000 pregnant women were found to be living with HIV in eastern and southern Africa, more than in any other region of the world.

The region is also home to 47 percent of the global total of children living with HIV, of which over 90 percent were infected through vertical transmission from the mother to the baby during pregnancy, delivery
or breastfeeding, the organisation added. In high-burden countries in southern Africa, HIV contributes to between 10 and 28 percent of all deaths among children under five years of age.

The organisation claims that thousands of women still shy away from ante-natal care for fear of discrimination by male partners and family while some were living in areas where such services were far away.

Barbra Engelsmann, Organisation for Public Health Interventions and Developments (Ophid) country director, affirmed that gender-related issues and violence were among a number of barriers affecting women seeking antenatal care.

“Field experience has shown that in some cases, gender can create barriers for the uptake of health services, and as a result, can limit uptake of eMTCT or HIV prevention services,” she said.

Musanhu argued that the existing negative trends on ante-natal care services are being stimulated by traditional midwives who assist mothers deliver babies in unsafe environments.

“The traditional midwives you (government) trained have become the problem and stumbling block to antenatal care,” Musanhu said at a recent workshop.

“They deliver babies without proper knowledge on developments around such issues.”

Specialists say the risk of mother-to-child transmission of HIV can be reduced to less than five percent through a combination of preventive measures.

These include initiating pregnant  and nursing mothers together with new-born babies on ART, hygienic delivery conditions and safe infant feeding.

However, resources are still a challenge to a government whose ART programme has largely been relying on the international donor community.

Finance minister Patrick Chinamasa, in his 2014 budget, allocated $337 million to health, a figure deemed by some partners as a far cry for the sector.

Zimbabwe has 1,2 million HIV positive people.

Half of them are on anti-retroviral treatment.

The recently launched new WHO guidelines are expected to increase ARVs demand from 860 000 to 1,2 million people.

This comes at a time the country has been struggling to avail anti-retroviral drugs to all HIV positive people using the old guidelines but government insists it has adequate drugs until 2016.

Musanhu, from successes scored in his area, encouraged stakeholders to amicably engage men as they are fundamental in achieving the millennium development goal aimed at eliminating mother to child HIV  transmission within the remaining 24 months.

“I have faced many challenges after me and my child tested positive but what I later realised was that enough education and the support of my partner was all I needed to live a healthy positive life. If I were forced to test, of course I would have been hurt then, but would be glad now,” Chifamba said.

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