By Laura Mundy
In this short fictional piece, our contributing writer Laura Mundy tells a story which is so often left untold. She considers how PMTCT (prevention of mother-to-child transmission) places full responsibility on a woman to protect her child from HIV; and in turn alienates or excludes the father’s role in this effort.
She is the topic of conversation among family, friends and neighbours. She can’t walk down her road without hearing people’s comments. Shunned and stigmatised, she’s fully aware that everyone has assumed why she’s not breastfeeding her baby. Sadly, their assumption is right; she has HIV.
She’s all alone when she finds out she is HIV-positive. She gets her results after being tested at her first antenatal appointment. She has no-one to cry, scream and shout with, no-one to hold her hand.
At the clinic, she’s asked if she always has access to clean, boiled water and money to buy formula feed. She responds, ‘yes’. From there, she is advised to completely avoid breastfeeding after she gives birth. Instead, she must formula feed her baby so she doesn’t give HIV to her new-born child.
Now at her second antenatal appointment, she’s had to go to a different location, to a PMTCT clinic. It specialises in the ‘prevention of mother-to-child transmission’ of HIV. She’s nervous because she’s still not used to seeing doctors. She waits patiently for her turn. Beside her, other pregnant women are jumping the queue.
‘Bring your partner along and you’ll be seen first’ – the sign reads.
Her husband, the father of her unborn child, knows that men are encouraged to come along and test for HIV at the PMTCT clinics in Nigeria. But he’s scared. He also thinks that babies are a woman’s responsibility and refuses to join her.
He won’t get tested so he doesn’t know his HIV status. She doesn’t know for certain how she became HIV-positive, but knows about HIV transmission from school so knows it could only have been from him. She has only had one sexual partner ever.
Her husband is the only one who knows she’s got HIV. The night she told him was the night the abuse started. New house ‘rules’. Forbidden to leave unless it’s to go to the clinic or to get food. Isolated. Alone. He doesn’t want anyone to know that she is living with So no-one will find out she has HIV. Or rather, he doesn’t want anyone to think he has it too.
When the baby is born, he pushes her to breastfeed so that the neighbours don’t start asking questions. Today it’s just verbal, but last week he pushed her so hard she hit her head. But she won’t give in… she won’t breastfeed.
Alone, she travels to get more antiretroviral drugs for herself from the clinic, buy formula feed, and take her baby to get tested at 2 months old. Alone, she returns to find out the results of her baby’s HIV test… alone she rejoices as it comes back negative.
Through all this she feels very lucky. Lucky that she’s had the choice of being able to formula feed. Lucky that she’s not one of those mothers with HIV who have to breastfeed, to avoid mixing formula feed with dirty water that could make their baby seriously ill.
And yet, she can’t help but feel angry and hurt at her husband. Alone, she had to work to ensure that their baby is HIV free. Now, she has to manage living with HIV, and take treatment for the rest of her life. It’s time he tested for HIV too.
This story is a fictional adaptation of a scenario that is all too familiar to many women around the world. It is based on accounts that I have read as part of my work as Senior Editor for an international HIV and AIDS charity.
Around the world, PMTCT is a well-utilised and highly effective HIV prevention programme. World Health Organisation guidelines state that if a mother who is living with HIV takes antiretroviral drugs (ARVs) throughout pregnancy and formula feeds her baby, the child is unlikely to get HIV. If formula feed is not an option, she can exclusively breastfeed whilst adhering to ARVs, which will reduce the likelihood of HIV transmission from breast milk.
But it’s the name of the programme I take issue with. The ‘prevention of mother-to-child transmission’ suggests that the burden lies solely upon the mother, with no responsibility on the father. Men need to become more involved in the PMTCT process. They need to test for HIV and they need to support their partner in decisions around the future health of their child.
I do not claim to understand the realities of what it is like for this particular woman living in Nigeria. Her story is used to highlight the frequent gender divide in the responsibility of preventing a child being born with HIV. Programmes should be developed that balance this disparity, recognise when a woman may be at risk of gender-based violence and encourage men to know their HIV status sooner.