“There were times a bus would stop because a woman on board was in labour and I would deliver her baby with no hesitation,” Wairimu explains.
That was until she began falling sick in 2012. Wairimu says that it took a while before she was diagnosed with the HIV virus. “As a married faithful woman, HIV was the last thing on my mind. When my husband tested negative, I realised that I must have contracted the virus through my work as a traditional birth attendant. I never wore gloves because most of them were emergencies and done in a hurry,” Wairimu explains.
At the time, she had seven children and wanted one more. In 2013, she became pregnant and refused to be put on antiretroviral (ARV) treatment. “I did not want people to know that I had HIV, besides my husband, no one else knew. Selling groceries, I knew I would lose customers. People still take time to embrace someone who is HIV positive,” she says.
When her baby was born last year, she was given supplements for her baby but afraid that people would wonder why she was not breastfeeding. “I chose to breastfeed until the staff at the clinic I was attending threatened to have me arrested. The baby tested positive for HIV. This has been a big burden on my conscience, I blame myself,” she says.
Maurice Okoth, a clinician at a Prevention of Mother To Child Transmission (PMTCT) centre in Nyanza Province says that the outcome might have been different had she been put on Option B+, a lifelong ARV therapy for HIV positive mothers regardless of their CD4 count, as is the requirement by the World Health Organisation as of June 2013.
Okoth says that this was in cognizant with the fact that the life of a mother is key to the wellbeing of the family. “When a mother is healthy, it means that the child is also healthy and the whole family does better when the mother is around.”
He further explains that in keeping with the Millennium Development Goal number 5 that targets to improve maternal health, one of the main targets is to reduce maternal deaths.
“In Kenya, maternal mortality rate is still very high at 488 deaths for every 100,000 live births.”
Okoth says that even more important is the fact that improving maternal health has significant implications on Millennium Development Goal four which targets to reduce infant mortality.
He said that most children under the age of five find it difficult to cope without a mother. In Kenya, UNICEF statistics show that the average deaths for those under five is about 77 deaths per 1,000 live births, it is however staggering in urban slums at 151 per 1,000 live births.
But rolling out Option B+ in the country has proved more challenging and it is yet to be rolled out in full scale as is the case in Uganda and Malawi.
Okoth says that Option B+ has many benefits to both mother and baby.
“When a pregnant mother is HIV positive, in addition to the mother being on ARV therapy, her baby is also put on neverapine for the first six weeks after birth, or until breastfeeding has stopped if she is unwilling to be put on lifelong ARV therapy,” Okoth says. He adds: “Not all mothers are willing to start on ARV drugs for life, especially if there CD4 count is above 350. It is a difficult decision to make.”
According to Dr John Ong’ech an HIV and AIDS expert as well as Assistant Director and Head of Reproductive Health Department at Kenyatta National Hospital there are challenges which have made it difficult to roll out Option B+ full scale and include the cost of the additional drugs, challenges facing the health sector as well as other societal issues such as stigma which continue to affect adherence to drugs.
Ong’ech says: “If you have a HIV population at a health facility on treatment but they are sick, this is a bad sign and points to other issues such as stigma.”
Wairimu says that it is because of fear that the society will shun them that some HIV positive mothers, who are not on ARV therapy, will continue to breastfeed, even when the risk of transmitting the virus to their baby has been made clear to them.
According to Dr Dave Muthama, Deputy Project Director at the Elizabeth Glaser Paediatric AIDS Foundation: “After birth, the baby is exposed to HIV through breast milk, and risk of transmission is high, almost equivalent to that of a HIV negative person having unprotected sex with a HIV positive person yet some mothers will breastfeed without adhering to the ARVs therapy just because the society will question why they are not breastfeeding.”
He further explains: “This is a very complex situation because we know that breastfeeding prevents diarrhoea, which is a leading killer among babies, so at times even in the face of risks of transmission, HIV positive mothers prefer breastfeeding.”
Muthama encourages health facilities offering Prevention of Mother to Child Transmission programs to strengthen peer counselling programs.
“A HIV positive mother supporting another HIV positive mother, who also goes to the same clinic for Prevention of Mother to Child Transmission services is one way to address the situation.”
This article was originally published in Inspiring Change - the International Women's Day special issue of the Kenyan Woman newspaper