Three per cent of women tested positive last year
By Samantha Alleyne
May 30, 2004
Ninety-six or 3.4 percent of the 2,783 pregnant women tested for HIV under the Prevention of Mother-to-Child Transmission (PMTCT) pilot project last year were found to have the virus.
More than half of the pregnant women approached at the PMTCT sites agreed to be tested for HIV. However, not all of those who tested positive delivered at public hospitals and were administered the single dose of nevirapine that reduces the risk of their babies becoming infected during birth.
Statistics available at the Family Health International (FHI) office revealed that between January and December last year 3,279 pregnant women visited the sites.
FHI, which has been supporting the Ministry of Health's pilot project launched in November of 2001, also revealed that of that number 2,783 agreed to be tested for the virus and some 96 tested positive. Seventy of those mothers delivered their babies at public hospitals and 55 were given the single-dose nevirapine (NVP) tablet early in labour; 65 babies were administered a NVP syrup 72 hours after their birth.
Despite the figures revealed in the pilot project however, USAID/FHI estimates that about five per cent of pregnant women in Guyana are HIV positive, which means that five out of every hundred pregnant women are HIV positive. In the past two years or so, more than 200 pregnant Guyanese women who were tested for HIV were found to be positive and the total is probably higher, as the testing programme was only available at eight clinics.
Guyana's PMTCT pilot project was launched in November 2001 at the cost of $23 million and was piloted in Regions Four and Six.
Being a part of the prevention of the transmission programme is a voluntary process which sees pregnant women being offered the opportunity to be tested for HIV; pre- and post-test counselling accompany the testing.
Initially, the drug company Boehringer Ingelheim donated the Nevirapine tablets, however, shortly after, the New Guyana Pharmaceutical Company (New GPC) began producing them. The NVP syrup, which is given to babies, is provided free of cost to Guyana from the drug company Cipla in India.
USAID's support to the programme began in September 2003, when Guyana became one of 14 countries to benefit from President George Bush's International Mother and Child HIV prevention initiative. Earlier this year, FHI became its implementing partner. The US$3.4 million programme in Guyana enabled women throughout the country to access HIV voluntary counselling and testing (VCT) services, and if tested positive, to receive drugs to prevent infecting their newborns, as was being done in the pilot project. The overall purpose of the US Government's support to Guyana's PMTCT strategy is to reduce current rates of transmission of HIV from mother to child by 50% by 2008 and continue to assist the government in expanding and strengthening the existing effort.
What is PMTCT?
A pregnant woman can transmit HIV to her child during pregnancy, labour and delivery and breastfeeding.
PMTCT has been defined by a four-pronged approach:
- Preventing the HIV infection of women of childbearing age;
- Preventing unintended pregnancies;
- Prevention of prenatal HIV infection, including VCT, short-course antiretroviral, safe infant feeding, and optimal obstetric practices;
- are and support for mothers and their family members.
Mother-to-child transmission of HIV can be almost completely prevented if all pregnant women receive HIV treatment to reduce the virus in their blood; if the child is delivered by caesarean section instead of a normal birth; and if the mother does not breast feed but instead gives only infant formula to the baby - this is called replacement feeding. And if all of these actions are not possible, transmission can still be reduced using a combination of strategies.
According to FHI's Programme Officer, Andrea Mc Adam some of the women who did not receive the single dose of NVP at the hospital, might not have refused the drug but might have arrived at the hospital too late.
There is a special number on the woman's chart which will indicate to the nurse or doctor that she is HIV positive. However, women who arrive at the hospital due to give birth in a few minutes or under an hour are not given the drug because it does not "make sense", according Mc Adam. She explained that the NVP is given to the woman to reduce her viral load, which means that there is less of an opportunity for the child to become infected. But if the mother is just about to give birth the drug would not help because it takes more than an hour to reduce the viral load; a woman who is just about to give birth might have already infected her baby. Women who arrive at the hospital two to four hours before delivery are given the drug.
Mc Adam told Stabroek News in a recent interview that there had been no reported difficulties in the administration of the drugs and even if babies throw up the medication, it was re-administered after a short period of time. Because babies have their mother's immune system up to 18 months after birth, they were not tested for the virus until then. However, in some cases mothers refused to allow their children to be tested at that stage.
Of 55 babies born to HIV-positive mothers who had visited PMTCT sites only 11 were actually tested at 18 months. The statistics revealed that just one of the babies tested positive for the virus. "Some mothers prefer not to come back and have their babies tested," Mc Adam said.
After testing HIV-positive the mothers are counselled on how to lead a healthy lifestyle so as to delay the onset of AIDS. Even those who do not want to be tested are counselled and there are follow-up actions taken in an effort to have them tested. "But as you can see we have a very good return on testing, 90 percent of the women in the period have been tested. They are not really refusing to be tested," Mc Adam pointed out.
PMTCT services have been expanded and the 18 sites in use now are: Vreed-en-Hoop in Region Three; David Rose, Campbellville, Festival City, Dorothy Bailey, Kitty, Beterverwagting, Georgetown Public Hospital Ante-natal Clinic and St Joseph Mercy Hospital in Region Four; Crabwood Creek, Number 64, Bushlot, Williamsburg, Cumberland, Fyrish and Skeldon in Region Six; One Mile, and Vivienne Parris in Region Ten.
At these sites, women who test positive are advised not to get pregnant again. However, it is a matter of choice and if they do not disclose their status to their partners then it difficult for them to refuse to get pregnant again.
According to reports, more than half of the HIV-positive women do not disclose their status to their partners and in most cases get pregnant a second time.
Because the women are being tested and their husbands are not, reports are that the husbands who are told of the results accuse their wives of taking HIV into the home when in reality it might not be so.
There have been attempts to get fathers involved since it is known that when women are tested alone and they reveal their status some of them are physically abused and thrown out of their homes. There has only been one instance in the programme where a father was interviewed but the statistics do not disclose whether he was tested or not.
Male partners' non-attendance at clinics is mostly a cultural issue. And according to McAdam, a number of clinics are not father-friendly. Often nurses do not want to see men and would question their presence there.
"Most times when men attend clinic with women it is a private clinic," the programme officer said.
"Those are things we [USAID/FHI] hope to work on once we are around long enough… on getting the clinics to be more male-friendly and so that both parents can be counselled and tested at the same time then they would be no room for anybody to say 'you gave it to me first'."
While HIV-positive mothers are advised not to breast-feed, it is a voluntary action on the part of the mother. It was pointed out that mothers might choose to breast-feed since they do not want people to assume that they are HIV-positive. Because of the whole issue of stigma and discrimination women who choose not to breast-feed for personal reasons and are not HIV-positive could still be viewed as someone who has contracted the virus.
The PMTCT programme advises women who choose to breast-feed on how to take care of their breasts so that the nipples would not become cracked thus increasing the possibility of them infecting their infants. Also, HIV-positive women insistent on breast-feeding are advised to exclusively do so and not to feed the baby with anything else and they should only do so up to three months.
In Guyana breast-feeding continues for a long period of time, so even though the amount of HIV in breast milk is small, breast-feeding the baby for a longer period extends its exposure to the virus.
After the women are given the drug at the onset of labour, they are given breast milk substitute free of cost and are further counselled. They are also encouraged to join clinics country-wide where anti-retroviral drugs are being administered so that they can be monitored and doctors can advise when and if they need ARV therapy. In Guyana, HIV-positive people are placed on treatment when they start to exhibit the signs and symptoms of AIDS.
Upgrading of major hospitals to facilitate rapid testing
The FHI programme includes the upgrading of the labour rooms of five public hospitals in Guyana and the training of staff members in these rooms on how to deal with HIV-positive women. The five hospitals are Georgetown, Suddie, West Demerara, New Amsterdam, and Mackenzie.
It is hoped that the upgrading of the hospitals will allow the programme to be accessed by women who are not reached at the different PMTCT sites. "That is how we are going to reach the women not reached at the antenatal clinics..." Mc Adam said.
She said it was important for labour room nurses to be properly trained as this would reduce stigma and discrimination since some people behaved differently towards HIV-positive people.
FHI's Labour and Delivery Co-ordinator, Colleen Anderson, explained that nurses would be trained to counsel the mothers before and after testing for the virus. According to her, the labour rooms will soon have rapid HIV testing which will see results being known almost immediately and not days later as is the procedure in Guyana at present.
According to her, student nurses who will be in the labour rooms would also need to be trained since they will also have to deal with the mothers. As a result the programme will include the training of nursing tutors and it is hoped this will eventually be included in the curriculum for the nurses.
And as part of the PMTCT programme, FHI has also designed a behaviour change communication (BCC) campaign that includes interpersonal, community-based and media - related activities to reach those who are HIV-positive. The campaign's aim is to increase demand for PMTCT services among pregnant women, promote use of VCT services, and encourage acceptance and adherence.
The BCC campaign is also expected to create widespread awareness of the magnitude of PMTCT in Guyana and the consequences of HIV during pregnancy and lactation and also to promote adoption and maintenance of the recommended PMTCT behaviours. It will also encourage social support for HIV-positive pregnant women and their families.
Guyana has one of the highest overall rates of HIV/AIDS in the Caribbean/Latin American region and it is estimated that almost 20,000 people are HIV positive. And according to a USAID/FHI handout only a small percentage of all Guyanese have had an HIV test. It stated that until more people are tested, the real numbers would not be known.
About 50% of all HIV-positive people in Guyana are women.
The US government is currently spending some US$10 million in Guyana in the fight against the virus, according to USAID's Mission Director, Dr Mike Sarhan.