Antiretrovirals prove a lifesaver; But HIV stigma continues

BY: Arku Jasmine

Cuddling her newborn son in her arms, Gifty shows him off proudly to family and friends but her joy is clouded by a secret she dare not share: She is HIV positive.

Gifty, who is 26, was shocked to discover her status when she took a test during a regular antenatal visit last year.

“I didn't believe it at first. I just cried," said Gifty, a market trader in Accra, whose real name has been changed to protect her identity.

Yet the test proved a lifesaver for both her and her son. She started taking antiretrovirals immediately and when her son was born in March, he tested negative for HIV.

A campaign by Ghana’s government, the United Nations and its partners to reduce mother-to-child transmission of HIV is bearing fruit. Antiretroviral drugs are more available and mothers are encouraged to take an HIV test early in pregnancy.

As a result, there was a 31 per cent drop in the number of pregnant women passing HIV to their children between 2009 and 2012. The reduction has been singled out as an African success story.

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At the same time, the percentage of women who tested for HIV and received counseling rose from 39 per cent to 71 per cent, according to data from the National AIDS Control Programme.

Under an ambitious global plan, Ghana hopes to eliminate transmission of the HIV virus from expectant mothers carrying the virus to their children by 2015. Gifty is just one of those success stories.

But the stigma about HIV-AIDS remains a huge stumbling block. Many people who could benefit from antiretroviral treatment refuse to get tested.

While Gifty told her husband she was pregnant, she initially concealed her HIV status from him. She mentioned that at first she would hide in the bathroom to take her daily doses of antiretroviral drugs. But a few weeks before her due date the strain became too great.

“Instead of being happy about the baby, I kept on crying and crying so he insisted on accompanying me for my last checkup. He said he knew something was up,” said Gifty. At the clinic, Gifty’s husband learned the truth.

He agreed to get himself tested and when the result came back it was HIV positive. The couple decided to keep the secret to themselves because they feared the reaction of their families. Even Gifty’s mother was not told.

Gifty’s newborn infant tested negative for HIV, something she is delighted about. But when she thinks of her family who have been kept in the dark about her status, a haunted look came into her eyes.

Antenatal Clinics

Many women in Ghana discover their HIV status during routine pregnancy checks at antenatal clinics. Gifty said the care and support by the nursing staff who disclosed the news to her helped her bear the shock. Antenatal clinics are at the heart of the campaign for the Prevention of Mother to Child Transmission - the global plan launched by UNAIDS and its partners to eliminate new HIV infections among children by 2015 and to keep their mothers alive.

While HIV prevalence among the general population in Ghana is relatively low at 1.5 per cent that among pregnant women is 2.1 per cent, echoing the disproportionate way in which the disease affects women across the continent.

African women make up nearly 60 per cent of adults living with HIV, according to UNAIDS data. In addition, about 900 children in low and middle income countries become infected daily.

Antiretroviral therapy given during pregnancy can reduce mother-to-child transmission to less than five per cent and maintain a mother's health. It also helps prevent a woman from infecting her partner. Without the drugs the percentage chance of infecting a baby goes up to 40 per cent or more.  

Gifty receives her antiretroviral treatment at the Korle Bu Hospital’s Fevers Unit - a leading centre for antiretroviral treatment in the country. Recent results for newborn babies born to seropositive mothers treated there confirmed the success of the unit’s prevention of transmission from mother-to-child drive, said Dr Ernest Kenu, a physician.

Out of 63 infants screened for exposure to the HIV virus between Januarys to December, 2012 at the unit, only three were found to be seropositive, Kenu said.

The mothers of those three had not been diagnosed until very late in their pregnancies and so had not received antiretroviral therapy, Kenu said.

Option B+

One method of treating pregnant mothers living with HIV, which is increasing in popularity, is the Option B+, which puts them on a lifetime antiretroviral drugs.

Option B+ has already been adopted successfully in African countries like Malawi and Rwanda. It offers all pregnant or breastfeeding women who are HIV positive a lifetime of antiretroviral drugs to protect their own health and that of future pregnancies. It also brings down the chances of transmitting the virus to a sexual partner to nearly zero.

Ghana has not yet fully adopted Option B+ but instead follows Plan B which treats expectant mothers living with HIV with a combination of antiretrovirals throughout pregnancy, during labour and delivery until a month after they stop breastfeeding, according to the National AIDS Control Programme.

Initial trials of the Option B+ plan in Ghana last year had hiccups mainly due to the limited capacity for specialised lab testing the option relies on and a shortfall in funding, Dr Nii Akwei Addo who heads the NACP said.

“Our national target is to see 90 per cent of all pregnant women in Ghana tested and given follow up counselling and antiretroviral therapy if needed,” Akwei Addo said, adding that the current coverage of pregnant women is around 70 percent.

One major concern is the women who don’t attend antenatal or don’t return to a referral clinic for follow up if they are found to be HIV positive.

A shortfall in funds for financing the mother to child prevention drive could also seriously affect its efficacy and allow expectant women to fall through the cracks, Akwei Addo said.

“It was simple,” she said. “I couldn’t have afforded a C-Section anyway,” she added.

Stigma about HIV-AIDS is still very prevalent in Ghana and remains “the last bastion” hindering progress against the disease, said Girmay Haile, UNAIDS Country Coordinator for Ghana.

For now Gifty is back and is still trading as well as bringing up her baby, who is thriving. He will repeat the HIV test when he is six months old. Hopefully, the results will confirm his current status.

By Amba Mpoke-Bigg/ UNAIDS Correspondent/Ghana