Mother and child
India has one of the highest pediatric HIV infection cases in South Asia. Concerted effort and long-term plans are needed to tackle the situation. Ranjita Biswas reports
Sajeda Bibi (not her real name) of a village near Dhulian town in Murshidabad district of West Bengal was inconsolable. The 30 year old woman had lost her husband one year ago due to HIV-related complications. She was pregnant at that time. Now she has found that not only has she been infected by her husband who was a migrant worker in Gujarat, but her six months old son is also HIV-positive. Her only solace in misery, little Salman, is one of the those children with MTCT (Mother to Child Transmission) of HIV.
According to NACO (National AIDS Control Organisation) women account for around one million out of 2.5 million estimated number of people living with HIV/AIDS in India.
There are many Sajedas in the country, mainly in low-income or semi literate sections of the society, who are unaware of the danger of getting infected with the HIV virus by partners who indulge in unsafe sex. Migrant workers while away from home are a major component of the section.
However, not all HIV infected women pass the virus to the child but the likelihood is high. NACO website informs: “An HIV-infected mother can infect the child in her womb through her blood. The baby is more at risk if the mother has been recently infected or is in a later stage of AIDS. Transmission can also occur at the time of birth when the baby is exposed to the mother's blood and to some extent transmission can occur through breast milk.”
UNAIDS says that most HIV-infected children die within two years of their life.
Many women like Sajeda in villages of India give birth at home, or do not go to antenatal healthcare centres (ANC), either due to ignorance or lack of facility in the vicinity of their homes. According to the National Family Health Survey (2005-2006) urban women between the age of 15 and 49 are almost twice likely to have received HIV voluntary counselling and testing than their rural counterpart.
According to UNICEF (Factsheet, 2010), in India each year 27 million women give birth, out of whom 49,000 are those living with HIV. Of them only one in five receive Anti Retroviral medicine (ARV) for treatment and Prevention of Mother to Child Transmission (PMTCT). Timely ARV treatment deters HIV-infection from progressing into life-threatening AIDS.
India “has the highest burden of pediatric HIV infection in South Asia,” points out Purnima Madhivanan of the Kisalaya project in Karnataka supported by the US-based Elizabeth Glaser Pediatric AIDS Foundation.
Problems of reaching expecting mothers with the facilities are many, especially in rural areas. A vast majority of women in low and middle-income countries have never been tested for HIV and they do not know whether they are infected or not. An effective PMTCT programmes must provide counselling and testing services to determine which women need assistance, experts say. They suggest an integrated approach i.e. PMTCT programmes integrated into existing public health systems with services provided by all antenatal and delivery clinics.
Use of other communication tools can be harnessed to generate awareness as the Kisalaya project shows. During its three-year programme, informs Madhivanan, it involved the community through outreach workers and trained medical staff and was able to reach more than 5000 community members (including 900 men). Usually held in community venues, the meetings involved presentations on birth preparedness, the importance of institutional delivery, risks during pregnancy and PMTCT. To stoke participants’ interest, the programmes included theatre, role-play, quiz shows with prizes. A mobile clinic was on a converted bus.
It has been known since 1999 that a simpler, inexpensive regimen of drugs can cut mother-to-child transmission rates by at least a half. Basically it comprises two doses of a drug called Nevirapine - one given to the mother during labour and the other given to her baby soon after birth. These short-course treatments, if combined with safer infant feeding (though usually breast-feeding is encouraged) can save many children from HIV infection each year, experts say.
In 2001, United Nations set targets for preventing mother-to-child transmission, as part of a landmark agreement called the UNGASS declaration calling for HIV reduction by 20% by 2005, and by 50% by 2010. Its approach to PMTCT includes HIV prevention measures and a range of care for mothers and children.
But few countries have reached this target. At the International AIDS Conference in Rome (July, 2011) Philippa Musoke (Uganda) of the Department of Pediatrics and Child Health, Maskerre University, argued at her plenary address that although progress has been made in reducing maternal and child mortality in most regions of the world , the improvement remains inadequate in most countries to meet the Millennium Development Goals ( MDG, 2015) no 4 : reduce child mortality and no 5: improve maternal health
Without an effective PMTCT programme instances like Sajeda’s, and many of her brethren, are bound to happen.
India’s National Programme Target by 2012 envisages: 80% of HIV-positive pregnant women to be reached by PMTCT services: 98% of pregnant women who deliver in the public sector to receive ARVs for PMTCT: 90% of HIV-exposed children to receive medication and have access to early diagnosis.
|
|
