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IRIN PlusNews HIV/AIDS News and information service | East Africa | KENYA: Progress on HIV parent-to-baby transmission, but UNGASS target still elusive | Care Treatment, Children, Prevention, PWAs ASOs, Stigma Human rights Law | Focus
Friday 15 December 2006
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KENYA: Progress on HIV parent-to-baby transmission, but UNGASS target still elusive

[This report does not necessarily reflect the views of the United Nations]

©  iThemba Lethu

Formula feeding reduces the risk of transmission via breastmilk

NAIROBI, 24 May (PLUSNEWS) - The comprehensive HIV/AIDS care clinic at Kenya's Machakos District Hospital buzzes with activity as nurses call out the names of the tens of women waiting - proof, according to the hospital's staff, that their efforts to reduce the number of children born with the virus are paying off.

"As you can see, the clinic is full of people - uptake of VCT [voluntary counselling and testing], ARVs [antiretroviral treatment] and PMTCT [prevention of mother-to-child HIV transmission] are all on the rise," said Dr Simon Mueke, the hospital's medical superintendent.

Machakos, a town about 50km east of the capital, Nairobi, on the Nairobi-Mombasa highway, has been badly affected by the ongoing drought.

At the United Nations General Assembly Special Session (UNGASS) on HIV/AIDS five years ago, world leaders committed to ensuring that 80 percent of pregnant women would have access to HIV prevention services. Although Kenya has not met the 2001 target, the government feels they have improved access to PMTCT services.

"We now have between 40 and 50 percent of all HIV-positive expectant mothers accessing PMTCT, and have trained thousands of health workers," said Dr Robert Ayisi, PMTCT coordinator at the Kenya's National AIDS and Sexually Transmitted Infections Control Programme (NASCOP).

Mueke noted that HIV testing at the Machakos antenatal clinic was now a standard part of the package, unless a woman specifically declined.

According to Margaret Kibutu, a PMTCT nurse at the hospital, "This year, since January, we have tested more than 600 women at the antenatal clinic, the highest figure since we started in 2003."

Despite these advances, challenges remain. "We need to develop the community component of PMTCT - we have services at the district level, but need them at the lower levels to ensure that all women have access to them," Ayisi commented.


More health workers, particularly in the rural areas, were required if a higher PMTCT uptake was to be achieved. "We are currently training traditional birth attendants in PMTCT," Ayisi said. "We want them to be our agents of change and pass the messages to mothers."

Ahead of the UNGASS review in June, the Kenyan government has recommended that donor countries take into consideration local traditions and cultural practices, such as traditional birth attendants, and make their policy documents more Afro-centric in order to incorporate valuable service providers.

Traditional birth attendants are more often present at deliveries than trained medical staff, and the government is encouraging them to join the fight against HIV by reducing the levels of stigma faced by HIV-positive women, among other services.

The stigma attached to HIV/AIDS often causes infected women not to follow the PMTCT guidelines, such as not breastfeeding, with which an infant has a 15 percent to 30 percent chance of contracting HIV.

"If you don't breastfeed your child, people wonder why, and conclude that you must be positive - this leads many women to carry on breastfeeding and putting their children at risk," said nurse Kibutu.

Poverty also led women to carry on breastfeeding because they could not afford replacement foods. Parts of Kenya are still gripped by a drought brought on by several failed rainy seasons, and baby formula is often unaffordable to the 56 percent of Kenyans living on less than US$1 per day.

Formula feeding reduces the risk of transmission via breastmilk by one-third. But this option presents another obstacle, as it requires a constant supply of clean water and firewood to ensure sterile feeding. Family pressure to breastfeed is strong, and mothers who formula feed are viewed with suspicion.

The alternative is solely breastfeeding for the first three to six months, followed by quick weaning, as mixed feeding can damage the baby's fragile gut lining, increasing the risk of infection.

"We now tell these women to try to breastfeed exclusively for six months if they cannot afford the [formula] milk - that way they do not introduce foreign foods that might disagree with the baby and increase the risk of infections," Kibutu said.

Stigma also heightened the lack of male participation in mother-child healthcare, further hindering the development of PMTCT. "Most men are very arrogant and do not want to hear about testing," she observed. "We only get men in the clinic once in a while, but PMTCT is really a family issue - the men should be involved."

Kibutu said many women failed to take their ARVs because they had not disclosed their HIV status to their spouses, which put them and their families at even greater risk. In response to the need for greater male participation, Machakos hospital has started including a 'Men As Partners' component in their PMTCT services.

"Men need to be involved in PMTCT, since they have more say in what happens in their homes," said Alice Wambugu, an HIV-positive behaviour-change volunteer with Population Services International (PSI), an AIDS prevention NGO.

Another factor preventing women from continuing their treatment, Kibutu said, was that many came from remote, rural areas and could not afford the bus fare to the district hospital for follow-up.

Ultimately, PSI's Wambugu said, all women needed to hear the message of PMTCT if they were to understand its importance.

"When I tell women that I found out I was HIV-positive at the antenatal clinic and went on to have an HIV-negative baby boy, they often say they didn't believe that a positive woman could have a healthy baby," she said. "We need an even bigger media campaign to let all of them know it is possible for them to have healthy children."


Recent KENYA Reports
Urgent action needed to avert resistant TB - activists,  13/Dec/06
Government introduces combination therapy for PMTCT ,  4/Dec/06
Activists upset as UK introduces TB screening for visa applicants,  30/Nov/06
Rising drug, alcohol abuse threatens HIV/AIDS gains,  29/Nov/06
Muslim women in the north defy custom to fight AIDS,  9/Nov/06
· AIDS Media Center
· The Global Fund to fight AIDS, Tuberculosis & Malaria
· International Community of Women Living with HIV/AIDS
· International HIV/AIDS Alliance

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