By Chiara Frisone
On 29 November, UNICEF released Children and AIDS: Sixth Stocktaking Report, the first report of its kind since 2010.
An AIDS-free generation once seemed like a far-off dream. But, now, the world has what it takes to make this dream a reality. Advancements in preventing mother-to-child transmission of HIV have greatly decelerated the rate of new infections in babies in low- and middle-income countries. However, the same progress has not been seen in treatment for children living with HIV, and the trajectory of AIDS deaths among adolescents living with HIV remains alarming.
Since the Democratic Republic of the Congo started rolling out Option B+, HIV-positive expectant mothers like Jeanne are finding care and support – and a simple regimen to help prevent transmission of the virus to their babies.
LUBUMBASHI, Democratic Republic of the Congo, 6 December 2013 – A group of pregnant women sit on parallel rows of wooden benches, listening to Nurse Alain Nzengu. Some nod, others frown or look puzzled.
Some of the women at this counselling session are hearing for the first time that it is possible for a mother living with HIV to pass the virus to her unborn baby.
Addressing HIV infection nationally
HIV prevalence in the Democratic Republic of the Congo is 1.1 per cent in adults aged 15–49. It peaks at 3.5 per cent among pregnant women attending antenatal consultations. In a country of more than 67 million people, this percentage translates into 1.5 million people living with the virus.
Integrating prevention of mother-to-child-transmission (PMTCT) services into antenatal care is essential to identifying pregnant women living with HIV as early as possible to keep them healthy and prevent them from passing the virus to their unborn children during birth or breastfeeding.
This year, the country introduced the Option B+ approach that has been so successful in Malawi. Option B+ is an innovative approach to eliminate new HIV infections in children. The Democratic Republic of the Congo’s plan offers lifelong antiretroviral treatment to all pregnant or breastfeeding women living with the virus. The simplified antiretroviral therapy consists of one pill, once a day.
Option B+ greatly lowers the chance of mother-to-child transmission of HIV in future pregnancies and helps maintain the mother’s health and reduce HIV transmission to uninfected sexual partners.
“This new approach – it’s the best option for the country because it does not require that pregnant women who tested positive to HIV take a CD4 count before being put on treatment, which was a challenge with the previous approaches,” says Health Specialist with UNICEF the Democratic Republic of the Congo Kalil Sagno.
Fighting HIV infection locally
The introduction of Option B+ allows health workers to offer antiretroviral treatment within local health facilities like the one at which Mr. Nzengu works, Saint Bernadette Health Centre, in the outskirts of Lubumbashi. Treatment is within easy reach of pregnant women living with HIV who no longer need to travel to one of the major zone hospitals to get their antiretroviral medication.
Mr. Nzengu, who is in charge of Saint Bernadette’s PMTCT programme, sees some 30 pregnant women per day. He asks every woman who has come to the clinic for the first time to take an HIV test. “They don’t have a problem accepting to take the test,” he says. “But, when they are given a positive result…some cry, others faint or simply are in shock, so we try to calm them down and tell them that it’s a secret between me and them – no one will know.”
Many people in the Democratic Republic of the Congo believe that a positive HIV test is a death sentence. “Some time ago, the word AIDS was taboo,” says Mr. Nzengu. “People are still afraid to even say the word AIDS…they just call it ‘that disease’.”
According to Jeanne*, one of Mr. Nzengu’s patients, “When Alain told me that there was a medicine that could improve my health, that people won’t notice [that I have HIV] and that my baby can be born healthy, I asked him if I could abort because I heard that when a woman is pregnant and has HIV she can die quickly.”
Jeanne was one of the first pregnant women to be offered lifelong antiretroviral treatment at Saint Bernadette. Mr. Nzengu supported and motivated her throughout her pregnancy. “When Alain told me [I was HIV positive], I lost peace in my life”, says Jeanne. “But, he said that if I take this medicine I will prevent my child from being born with HIV. This medicine gives me more reassurance that my baby will be fine, although, initially, I could not believe it.”
Working with the community
The introduction of Option B+ makes the job of health workers like Mr. Nzengu even more important, as they are key in dispelling myths about HIV and reassuring women living with the virus that preventing transmission to their unborn children is, indeed, possible.
And Mr. Nzengu believes that putting more pregnant women on treatment for life will have a ripple effect within the community. “When a woman sees another woman changing from being thin and weak to being strong and healthy, she’s going to tell her friends that there are very effective medicines at the health centre,” he explains.
“This way, we hope that, in 2015, we will have reached our objective of zero new infections and zero babies born with HIV.”
*Name has been changed.
Currently, 9 out of 10 pregnant women living with HIV do not receive antiretroviral medicines to prevent mother-to-child transmission of the virus. To date, lifelong treatment for all pregnant women living with HIV has been rolled out in five health facilities in Katanga, which is one of the provinces with the highest HIV prevalence in the country. It is expected that, with this new approach, more pregnant women living with the virus will be put on treatment, thus reducing the number of new infections in children.