Mothers at the forefront of change

A series of articles by guest writers for World AIDS Day Part of AVERT's World AIDS Day 2012 campaign, ‘Reflections on the Epidemic’ are a series of articles by guest writers. Our guest writers range from global leaders, writers, experts, activists, physicians and people personally affected by HIV and AIDS; and they represent various countries, experiences and backgrounds from all over the world. We are grateful to all our guest writers for their effort and the diverse and insightful viewpoints that they contributed to the world’s response to HIV and AIDS. We will be re-featuring these articles over the next few weeks on a weekly basis. Browse through this week’s featured articles, and see the full list below.

Mother to child transmission of HIV is almost entirely preventable. With access to testing and treatment, women living with HIV can go through pregnancy, delivery and breastfeeding with an expectation that infants will remain free of HIV. And yet, in 2011, 330,000 children were newly infected with HIV.¹ Of these, 90 percent were born in Africa, where most health systems lack capacity and resources to achieve the best outcomes and women are less likely to take advantage of increasingly available health preserving interventions.

The challenges are many. On the “supply” side, health systems need to have adequate staff to meet the demands of patients coming for care. Africa bears 25 percent of the world’s disease burden, yet has only 3 percent of the world’s doctors and nurses.² Women who come for care experience long waits, little time with health care providers and often leave more confused than reassured. Tests and medicines need to be available. In Nigeria, Democratic Republic of the Congo and Ethiopia, 25 percent or fewer mothers are getting an HIV test and less than 10 percent of mothers with HIV receive PMTCT medicines.

On the “demand” side, if women do not initiate care and do not remain in care, neither they nor their babies can benefit from medical services. In Nigeria and Ethiopia, 58 percent and 28 percent of mothers initiate antenatal care, but only 47 percent and 12 percent, respectively, attend four visits.³ In South Africa and Zimbabwe, where >95 percent and 78 percent of HIV positive mothers are given antiretroviral drugs (ARVs) during pregnancy; only 38 percent and 19 percent of these mother-infant pairs receive ARVs to reduce HIV transmission during breastfeeding.⁴
 
mothers2mothers (m2m) recognises and addresses these supply and demand side challenges. Employing mothers living with HIV as “mentor mothers”, m2m staff are trained and paid to work in health care facilities, supporting efforts of over-extended doctors and nurses. Mentor mothers, former patients who return to the hospitals and clinics where they received care as service providers, understand the competing priorities and barriers faced by mothers living with HIV. Mentor mothers provide education and psychosocial support to pregnant women and new mothers. This encourages uptake of medical interventions that reduce mother to child transmission of HIV and retention in the health care system so that they and their babies can benefit from on-going medical care. They encourage pregnant women to accept HIV testing during pregnancy, ensure that clients understand how to take their PMTCT ARVs, enlist women who are eligible for life-sustaining ARVs (HAART) to adhere to treatment regimens, motivate for birthing in a health care facility, follow postpartum mothers to bring infants back for HIV testing and promote family planning, child nutrition and infant immunisations.

mothers2mothers works. In 2011 in Zambia, 80 percent of m2m clients delivered in a health care facility compared to the national rate of 47 percent. In Lesotho, the respective rates were 78 percent and 59 percent. In 2011 in Malawi, among clients who attended m2m four or more times, 87 percent received ARVs, compared to a national average of 58 percent.

Appreciating that keeping women and children in care requires linking health care facilities and communities, mothers2mothers is engaging in community outreach efforts. As cell phones become increasingly available to clients, sending text messages or calling clients who do not return for important health visits becomes an accessible strategy for improving retention in care. Home visits can be made to those who don’t respond to these entreaties. mothers2mothers’ mentor mothers seek to bridge the divide between facility and community service to ensure that women remain in care and get the best outcomes.

The Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive (Global Plan) was launched at the United Nations in 2011 and promotes efforts to reduce paediatric HIV infections by 90 percent and halve the number of HIV associated maternal deaths by 2015.⁵ Mentor mother services are written into the Global Plan as an essential service. At present, mothers2mothers provides service in seven countries in Africa (Kenya, Uganda, Tanzania, Malawi, South Africa, Lesotho and Swaziland), with over 600 program sites employing nearly 1500 mentor mothers as of August 2012. m2m’s future efforts, aligned with the Global Plan, will be directed towards developing capacity in governments to deliver mentor mother programs with the support of local partners.

In 2012, we can reflect on where we’ve come from in the last 30 years. We can recognise and celebrate the tremendous progress that has been made on so many fronts. With access to care, people can count on living long, fulfilling lives with an infection that can be regarded as chronic. Families can look forward to having children in relative safely. With these changes, the stigma and discrimination associated with HIV infection fades. And yet, for so many, these possibilities are still out of reach. mothers2mothers is at the forefront of change, ensuring that women living with HIV can have HIV negative children, care for their families and “live positively” in a world of opportunities.

Dr. Mitchell Besser is the Founder and Medical Director of mothers2mothers. As an obstetrician and gynecologist, his professional career has been dedicated to the public health needs of women. In 1999, Dr. Besser joined the University of Cape Town's Department of Obstetrics and Gynecology, assisting with the development of services to meet the needs of pregnant women living with HIV and to prevent the transmission of HIV from mothers to their children (PMTCT). He has received many awards for his work including the Global Health Council’s Best Practice Award.

For further information on the prevention of mother to child transmission of HIV in practice, see AVERT's page.

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