There are still many who give birth at home increasing the risk of HIV transmission from mother to child. Studies show that mother-to-child transmission of HIV can occur during pregnancy, at delivery or during breastfeeding in the absence of preventive measures. In developing countries, statistics show that, in the absence of intervention, around 5% of HIV exposed children are infected during pregnancy, 15% at delivery and around 10% during breastfeeding (ARC, PMTCT resources). Moreover, 2010’s national health statistics estimated total adult HIV prevalence at 2.4%, while total HIV positive births were 14,276 from a total of 90,311 HIV positive pregnancies (FHAPCO, 2007). Although HIV infections among infants are relatively small when compared to adult infections, 90% of pediatric infections are due to vertical transmission of HIV from mother-to-child which can largely be prevented (Guidelines for PMTCT in Ethiopia, 2007).
To find out how provider initiated HIV counseling and testing was being implemented; we went to Gandhi Memorial, the oldest maternity hospital in Addis Ababa. When we got there, we were met with mentor mothers engaged in informing and mentoring pregnant women about PMTCT and the benefits of being tested complementary to what is offered as routine tests by health care providers. These HIV positive mentor mothers make rounds for certain hours of the day to raise the awareness of pregnant women about PMTCT and give psychosocial support to those who need it. They do this by organizing coffee ceremonies to introduce them with mothers who had passed through the same process and by sharing their own experiences.
We also spoke to Sr. Etalemahu, the nurse in charge of the PMTCT unit at the hospital, and asked her what major challenges they face as health care providers when it comes to implementing PMTCT program. She told us the major challenges were related to lack of awareness such as pregnant mothers coming for the first time during labor without having had any antenatal care, husbands not taking part in counseling and testing with their pregnant wives and unwillingness of economically dependent HIV positive mothers to tell their husbands their serostatus in fear of being left by them.
Gandhi memorial hospital, from a total of HIV free babies delivered to HIV positive mothers, has delivered 500 HIV positive births since it started giving PMTCT services in 2000 E.C. According to nurse Etalemahu, these were mainly due to improper taking of the prophylaxes, late initiation of medication and mix feeding of breast milk with formula, among other things.
According to the National Guidelines for PMTCT, Ethiopia has set a goal to attain zero HIV positive births by 2020. For this to be accomplished, pregnant mothers need to be encouraged to have antenatal, postnatal and delivery care in a health care setting or to have skilled delivery where they can get ART and ARV prophylaxis both for themselves and their child. In addition, mothers need to get sufficient counseling and education as to how to feed their infants and when to visit health centers at the first sign of illness. On the other hand, couples should also be encouraged to be tested before becoming pregnant and to make regular visits to health care centers during the course of their pregnancy. For these, both PIHCTs and VCTs play an important role and should be highly promoted.
