"It was the most difficult decision to make in my life, but I knew that I had to do it for the sake of my unborn child. The pre-testing counselling we received also helped a great deal," recalled 24-year-old Nthabiseng Rannyali who decided to undergo HIV testing to protect her unborn child.
Rannyali, who tested HIV-negative, was among a group of expecting mothers who were advised by doctors at St James Mantsonyane Mission Hospital, in Thaba Tseka district, about 200 kilometres outside Lesotho's capital Maseru, to undergo HIV testing.
The Mantsonyane health service district is one of the poorest in Lesotho, where only about 15% of residents have access to salaried employment. The majority have to survive on farming and occasional community projects run by government and sometimes non-governmental organisations (NGOs).
The mission hospital supervises a network of nine health facilities, serving a population of 64,000 spread over an area of 2,000 square kilometres.
The PMTCT programme is part of the Lesotho government's initiative to accelerate universal access to HIV prevention, treatment, care and support by 2010. It aims to increase the number of HIV-positive pregnant women who receive a complete course of ARV prophylaxis to reduce the risk of mother-to-child transmission by 80%.
Health personnel say the response to Lesotho's PMTCT programme has been encouraging. The number of facilities providing PMTCT has risen from nine in 2004 to 166 by the end of 2008. The number of women who received PMTCT and subsequent antiretroviral (ARV) treatment increased from 421 in 2004 to about 5,000 by end of last year, according to 2009 National AIDS Council statistics.
However, the clinics have started to face a number of unexpected challenges. Chief among them are cultural beliefs and stigma associated with HIV and AIDS.
Primary health care coordinator at St James Mantsonyane Mission Hospital, Khanyane Mabitso, says stigma and cultural beliefs make it difficult for medical personnel to follow up on HIV-positive mothers and their babies.
"There is still a lot to be done after delivery. We have to keep advising the mothers on personal hygiene, nutrition, drug taking and other issues, but some women disappear soon after delivering when they know of their HIV-positive status," he said.
"Due to stigma still associated with the disease, they fear people in the community might get to know about their status and look down on them," Mabitso explained.
Apart from stigma, cultural beliefs prevent women from returning to the clinic where they know health workers will advise against exposing their babies to traditional rites and herbal medicine. Some women, for example, feed their newborn babies with herbs to make them strong, while others believe that feeding or bathing babies with shrubs help them fight diseases and make them immune to attacks from witches.
Moreover, a local myth stipulates that if a baby refuses to breastfeed, its mother committed adultery during pregnancy. As a result, HIV-positive mothers are reluctant to choose exclusive formula feeding.
HIV-positive mothers who have given birth to HIV-negative babies through PMTCT are counselled to bottle feed their babies, because of the high risk of infection through breastfeeding.
"There is a high level of illiteracy in this area, and we work to ensure that mothers know how to choose [between breast and formula feeding] and how to use the formula milk," Mabitso told IPS, adding that many women continue to ignore health workers' advice and alternate between feeding methods, often due to pressure from older, female family members who think they know better.
On the upside, more and more women, such as Rannyali, now understand the need to undergo HIV testing when they fall pregnant, to protect their unborn babies.
The introduction of PMTCT in the St James Mantsonyane Mission Hospital also helped "to promote HIV prevention messages across many communities within the health service area," according to independent consultant Ascension Martinez. The programme also encouraged people to come for voluntary counselling and testing and attend support groups.
"We can now safely say that more people have information about HIV and AIDS through education and training, but it is still difficult to evaluate [the programme's] influence on behaviour change," Martinez observed.
Lesotho's National AIDS Council plans to implement the PMTCT programme in all of the country's 128 district councils over the next few years.
Article published courtesy of IPS Africa
