Patricia Mubanga, a midwife at the World Vision-supported Zamtam Prevention of Mother-to-Child Transmission (PMTCT) Clinic in Zambia, explains about the clinic’s procedures for helping HIV-positive mothers give birth to healthy, HIV-negative babies.

November 2009

By Collins Kaumba, World Vision Zambia, and Rachael Boyer, World Vision U.S.

When a woman tests HIV positive at the clinic, she immediately begins anti-retroviral (ARV) treatment. Then, a midwife gives her a drug called Niverapine that the woman keeps at home so she can take it as soon as she goes into labor. “We give this drug in advance because labor occurs anytime,” says Patricia, “and the mother may not have an opportunity to deliver at the clinic.”

Before delivery, the mother is asked to choose the mode of feeding the baby. Since HIV can be passed through breast milk, women are encouraged to use formula if they can afford it. Those who choose breastfeeding, or cannot afford formula, are encouraged to not breastfeed longer than six months.

An HIV-positive mother comes to the PMTCT clinic for regular checkups until she goes into labor. During the delivery, the midwives avoid rupturing the membranes and they also avoid episiotomies (a procedure that artificially enlarges the birth canal), since those practices increase the baby’s risk of being exposed to his or her mother’s fluids, and therefore, her HIV.

Patricia explains that once a baby is born, they quickly wipe off his or her body to remove fluids and blood that could contain the virus.

The new baby is then given another special drug called Zidovidin for a week. The mother also continues her ARV treatment.

The baby is tested for HIV once born, and is tested again at 6 months of age.

Both the mother and baby receive checkups, regular tests, and monitoring to combat any other infections that could occur.

Prevention challenges in Zamtan

According to Patricia, some HIV-positive mothers do not share their HIV status with their husbands.

“We advise HIV-positive mothers who are married to bring their husbands for testing and counseling,” says Patricia, “but they decide to keep their status a secret for fear of losing their marriages. As a result, re-infections are making these mothers and their spouses vulnerable.”

The Zambian government mandates HIV testing for pregnant women. However, some women do not want to know their HIV status. Sometimes, women have a hard time processing their diagnosis, even with all the help and support at the clinic.

“Some pregnant mothers refuse to take their results after testing,” Patricia says. They sometimes come to accept their diagnosis when they are about to deliver. However, by then, vital ARV treatment has already been delayed, increasing the baby’s risk of being exposed to HIV.

Patricia explains that women who forget to stop breastfeeding after the six months, or simply refuse to stop, often expose their children to HIV. “As a result, children that are born negative are exposed, and in most cases, test HIV positive even after 18 months.”

Prevention successes

“Since June 2008 to date, we had 42 babies born from HIV-positive mothers,” says Patricia. “Out of the 42, only four babies tested HIV positive; we’ve been monitoring these children and their mothers for counseling and testing to ensure everything is well.”

She adds that HIV diagnoses are actually helping parents live longer because they can begin ARV treatment, which keeps their children from becoming orphans at a young age. The clinic also provides treatment for opportunistic infections and psychosocial counseling.

About three years ago, HIV-positive children in Zambia risked dying early because lack of drugs, facilities, and infrastructure meant they did have not access to ARVs. But now, with help from government grants and organizations like World Vision, the story is changing.