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TOGO: Battling men's reticence to have pregnant women tested for HIV

More than 18 months into a programme to prevent mother-to-child transmission of HIV in Togo, half the pregnant women approached are still refusing to be tested for the virus during prenatal consultations, often because of pressure from their male partner, doctors said.

Most of the pregnant women in the waiting room of Be hospital in a working-class suburb of the capital Lome told IRIN they would agree to be tested.

The mothers-to-be were conscious that even though they might be HIV positive, they could still stop the virus from passing on to their child.

"I would do it at the very least to save the life of my baby," said one.

The risk of HIV transmission can be eliminated or considerably reduced by administering antiretroviral (ARV) drugs to pregnant women and newborn babies in the hours following delivery.

But Dr Gbandi Djinadou, who manages Be hospital, said since the start of the programme to prevent mother-to-child transmission only one out of every two pregnant women coming in for medical consultation had agreed to be tested.

"Women are under a lot of pressure from husbands not to be tested. Men are the main obstacle to the programme", Djinadou said.

Seven percent of all pregnant women tested in Togo who turned out to be HIV-positive, said Dr Raissa Tchama, head of the mother-to-child transmission prevention programme for the National AIDS Control Programme (PNLS).

The programme provides medical and psychological care for HIV-positive women and their babies throughout pregnancy, during delivery, and for several weeks after childbirth.

It was launched by the government in 2004 with the support of the United Nation's Children’s Fund (UNICEF).

This year the programme has also received support from the World Health Organisation (WHO) and over US $1 million from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

At present, nearly 4,800 women and their children are being treated with ARVs free of charge under the programme in five pilot medical centres in Togo.

Four of these centres are in Lome and the fifth is in Tsevie, 35 kilometres north of the capital. The programme is due to be extended to other parts of the country in the coming weeks.

No testing for fear of being rejected

Tchama of the PNLS said that many mothers-to-be were reluctant to be tested because they knew what had happened to other HIV-positive women who had gone through with the test, despite their husbands' warnings.

"Some of them were kicked out by their husbands and rejected by their family. They lost the will to live. They say they just want to die, now," she said.

Those running the programme noted that even when Togolese men are not fundamentally opposed to HIV testing, they still do not encourage their pregnant partners to clarify their status.

Kossivi, a university graduate is one of these. He told IRIN that his partner was about to give birth. "My girlfriend told me she did not want to be tested. I don't care about it either, so I didn't force her," he said.

Some women refuse to be tested for fear of discovering they are HIV-positive, admitted Massan, a 22 year-old woman who is three months pregnant.

Others just don't want to admit that they are under pressure from their partner.

Afawi, who is six months pregnant, said: "I'd rather die with my child. If he is still alive after I'm dead, who is going to take care of him?"

Even when a Togolese man finds out that his pregnant partner is HIV positive and accepts the fact, he does not always admit that he too needs to be tested and treated.

Fati said her husband allowed her to get tested on the advice of the doctor when she became pregnant.

She found out that she was HIV positive and told her husband, who realised that he probably was too. But he still baulked at confirming his own status. "He said logically speaking he should be HIV-positive too. So we decided to practice safe sex but he never got tested himself," Fati said.

She and her baby were both given ARV drugs to prevent mother-to-child transmission, but her husband now refuses to allow their child to be tested to verify whether the treatment has been successful.

"I followed the doctor’s orders. Our baby is now three and he looks healthy. But my husband still refuses to have him tested. It's a very tough situation," Fati said.

Promising results

Doctors have only one way of dealing with a husband's denial and reluctance to let his partner or child be tested: tactful persuasion.

"All we can do is talk to the people involved and try to convince them. There's no other way," explained Dr Ebenezer Agbetiafa, a pediatrician at Be hospital.

But sometimes talking is not enough.

One of Agbetiafa's HIV-positive patients lost her first baby at birth.

"He was a premature baby. The husband hadn't been infected. We told them to use condoms but they didn't listen. The woman got pregnant again and lost her second baby," he continued.

Despite the doctor's repeated warnings, the couple decided to try again. At that time, the husband was still HIV-negative.

"The third time around, the woman and the baby died, and the husband got infected," Agbetiafa concluded

Doctors on the mother-to-child transmission programme are disheartened by such stories, especially since they know that the ARV treatment works when families adhere to it.

Tchama of the PNLS said that after 18-months of monitoring babies who have received the prevention of transmission treatment, 83 per cent of babies born to HIV-positive mothers are still HIV-negative.

Government officials said these encouraging results should be act as an incentive to donors to extend the programme to the rest of this small country of less than five million people, which has an overall HIV prevalence rate of six percent.

The idea is to set up a treatment unit for pregnant HIV-positive women in every health centre by 2006, said Dr Arnold Ahiatsi, a coordinator for the Global Fund in Togo.

"Some health professionals are already trained and the buildings are being rehabilitated. Some of the centres should be operational by the end of the month," he said.

Despite the problems, doctors are always ready to talk about the success stories that encourage them to persevere.

Tchama told of one prosperous trader, who discovered that he was HIV-infected, along with his two wives and single child.

Thinking that he and his family were all doomed to an early death, he began merely living for the moment.

Then one of his wives became pregnant and was put onto the mother-to-child prevention programme.

"The child wasn't infected and is still healthy today," Tchama explained.

"When the father became aware of this, he bought land and built a big house on it. Every time I pass by their house, I remember this story and it makes me feel good inside," she said.

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