In April the government halted the distribution of free baby formula to mothers in order to promote exclusive breastfeeding for six weeks. Although this helps to prevent babies dying from diarrhoea or pneumonia (associated with dirty drinking water) some doctors fear this might reverse the gains South Africa has made in programmes to prevent mother-to-child transmission of HIV.
In April the government halted the distribution of free baby formula to mothers in order to promote exclusive breastfeeding for six weeks. Although this helps to prevent babies dying from diarrhoea or pneumonia (associated with dirty drinking water) some doctors fear this might reverse the gains South Africa has made in programmes to prevent mother-to-child transmission of HIV.
Candice Struthers, an Honours student in Health Journalism at Rhodes University, reports.
The distinct rattling of pills hitting the hard plastic of their containers fills the room as Amanda's* small hands fumble to arrange a very specific concoction of tablets. Her head nods up and down as she counts: “Two from this one, one of these and one from this one!”
At five years of age she cannot yet pronounce the names that make delicate rings around the cylindrical tubes. All she knows is that if mummy takes these pills she is not going to die.
Mxalisa Ntuthu refers to Amanda as ‘mini-me’ because they are the spitting image of each other. “She’s tall and chubby like her mummy,” she says. Beyond what immediately meets the eye, another thing sets them apart – Ntuthu is HIV-infected and her daughter is HIV free.
Last year Ntuthu’s CD4 count dropped below 350. CD4 cells help the body fight off disease so when they drop below 350 one qualifies for Anti-retroviral Therapy (ART) to stop the virus from multiplying. Amanda has since claimed the proud title of her mother’s very own ‘treatment supporter’ and helps her mother remember her medication every evening.
They share a very special bond and a very special story. “The fact that you are HIV-positive does not mean that you forfeit your right to reproduction,” Ntuthu says. She was eight years into her diagnosis when she decided to have a child and is adamant that the prevention of mother-to-child transmission (PMTCT) programme is tailor made for HIV-positive women.
Johannesburg based gynaecologist and obstetrician, Dr Coceka Mnyani says it's not perfect, but explains: “There is no prevention method that is 100% effective. We have to put all the bits and pieces together to increase the effectiveness of what we do. But even when you do that, HIV prevention can never be fool-proof."
But young Amanda's mother was not oblivious to this reality. Her PMTCT journey started long before Amanda's conception and, as she believes it will always be her responsibility to protect her daughter from HIV, this journey has become a part of her life.
“Education, education, education,” is the message Ntuthu believes to be most important. She is an advocate for HIV education and is renowned in her community as a public speaker, spreading messages about safe sex and condom use.
It therefore shocked many of her friends and colleagues that a well-educated woman like herself would choose to fall pregnant while living with the virus. “You are a public speaker, what are people going to say about you when you are walking around with a bloated tummy?” she recalls one friend saying.
What their judgement may have overlooked, however, was the way in which her education allowed her to plan a responsible and successful pregnancy. She often jokes, “My HIV is very academic.” “I decided to be a single mother. A lot has changed, we are more empowered as women. We are working and are in a better position to raise our children irrespective of having male partners in the set-up,” she says.
So Ntuthu’s journey to motherhood began. At the time of her pregnancy, between 2005 and 2006, South Africa’s PMTCT programme was in the pilot phases of dual therapy that improved it.
This regimen used a single dosage of Nevirapine (NVP) for the mother and the newborn during labour, and thereafter the newborn receives another ARV, Zidovudine (AZT) for the first six weeks of life. Much to their irritation, the Ntuthu never failed to ‘educate’ the nurses about this very regimen that would reduce the risk of transmission by 50%.
After all, “it was not only about me anymore, it was also about my daughter”. “It worked for me, as Ntuthu,” she says and her daughter’s HIV-negative status is a clear reflection of this.
Being a working mother she could afford to buy formula milk and having access to clean drinking water meant that the milk was safe and healthy for Amanda to drink. The combination of different liquids characteristic of mixed feeding can cause abrasions to the newborn’s oesophagus, allowing HIV-contaminated breast milk to mix into the baby’s system. This is why exclusivity of feeding is so important.
Since 2009, PMTCT programmes in South Africa have been adapted to the 2006 World Health Organisation guidelines. Paediatrician Hoosen Coovadia, of the University of the Witwatersrand, who has written extensively on the programmes, forecasts a positive future for these services with dropping prices of ARVs, better drug awareness and improved government support.
However, tensions are rising in the country in response to the new breastfeeding policy that was introduced on 1 April this year. The controversial policy has stopped free and state-provided formula milk to promote exclusive breastfeeding for six weeks. This method has shown to decrease child mortalities linked to diarrhoea or pneumonia, associated with dirty drinking water.
But Mnyani believes this decision was rushed and reveals that many people fear the policy might reverse the gains South Africa has made in PMTCT. While these changes show some benefits they also highlight the challenges of PMTCT in what Mnyani refers to as a ‘heterogeneous’ country. “There is something wrong with saying ‘we won’t provide you with formula milk’. You can’t make one policy for everybody,” she says.
Ntuthu managed to overcome every challenge in her path and her commitment to her PMTCT programme was much like the 40 weeks she carried Amanda – to full-term. But she acknowledges that some mothers may fall victim to certain personal and policy-related barriers when trying to have a child while living with HIV.
“At the end of the day you have a right to choose whatever journey you want to take, [and you need to understand]the responsibility that is attached to [that choice],” she says. Ntuthu’s story confirms that it is possible to ‘tailor’ a PMTCT programme around certain contexts and conditions, some of which cannot always be anticipated but some that can be overcome.
Ntuthu swallows the pills and recalls the day baby Amanda’s HIV-test results came back. “I was literally in tears. I was so happy that I managed to do everything to protect my daughter from contracting HIV.” She hopes Amanda is able to retain this status for the rest of her life by making wise relationship choices in her future.
*Not her real name
