Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date.
International Federation of Red Cross and Red Cresent Societies - 1 September 2003
John Sparrow and Selma Bernardi in Chitungwiza, Zimbabwe
Monday
6.45am
A bright morning does not lift the depression over the industrial town of Chitungwiza, south of Harare. Mamerida Tanda, 34, one of Zimbabwe's legion of young widows, has much to think about in the hour and a quarter it takes to walk from her home in Unit D to the Red Cross home-based care post in a local clinic.
It isn't easy bringing up four children alone in a tough urban environment reeling from humanitarian crisis and deepening economic recession. There's the rent, the water and electricity bills, the school fees and uniforms, the daily struggle to put food on the table, and one over-riding consideration.
Like a third of the adult population she is living with the human immunodeficiency virus (HIV). More than that, as a Red Cross volunteer bringing home-based care to her neighbourhood, her days are filled with helping others to "live positively" as well.
9.30am
She crosses a yard off a backstreet, and calls out through a half-opened door. A voice responds and she enters a darkened room with a concrete floor and low corrugated iron roof. In the gloom a woman is waiting for her.
Alice is 31, alone, afraid and penniless. She is also eight months pregnant. Mamerida calls in twice a week and is the person Alice confides in. Driven into the social shadows by the stigma of HIV, the woman trusts no one else.
She has reason. Her neighbours have figured that she is HIV-positive - her skin infections betray her. And, she says, they are laughing at her.
Alice hopes to God her baby will live. Her other five children are dead, the last four succumbing to wasting illnesses before the age of two. Why no one suspected HIV until after the final death is worrying in a country with such a high prevalence. But it was only then that Alice was tested.
The Red Cross worker can relate to the subsequent devastation. It was the recurrent illness of her own youngest child that prompted Mamerida's test. Her little girl, too, is now dead.
Already widowed, she struggled on for the sake of her other, healthy children. Alice, though, went to pieces. When the news came through of her infection, her husband left her and the in-laws they lived with threw her out.
She ended up on the streets, sleeping in doorways and eating out of the trash. The fear is that she could soon be back there. A Red Cross HIV support group helped her find this place. It isn't much but it's cheap. Alice, though, has no income and has not yet managed to pay any rent. Eviction could come before she gives birth.
Mamerida will be there and do her best to help. For now she dresses her wounds and counsels her. She talks of infection control, the importance of nutrition in positive living, and brings her Red Cross food parcels. Her skin has improved with her diet. Alice says just having someone to talk to is important.
Whatever happens, her baby will have a chance. Alice has been admitted to a programme to prevent mother-to-child HIV transmission. Almost 90 per cent of all HIV-infected children (some 2.7 million in 2001) live in sub-Saharan Africa and the virus has reversed years of improvements in child survival.
There is more than one cause, but mother-to-child transmission is the major one, with rates reaching up to 30 per cent, and up to 45 per cent with prolonged breast feeding. The most dangerous time is during labour and delivery but an anti-retroviral drug called nevirapine can cut rates by half.
Alice will take one nevirapine tablet when her labour begins, and her child will receive an oral dose within 72 hours of birth.
Mamerida is planning for Alice to deliver in hospital and have her counselled on the risks and benefits of infant feeding options. Breast feeding can add to the risk of HIV transmission although lack of it can increase the risk of other infectious disease and malnutrition.
There is one complication. Alice has an unpaid bill from her last hospital visit which means two things could happen. The hospital could refuse to take her or hold her after the birth until both her bills are paid. Mamerida is working on the latter. Better a prisoner of the health service, she says, than on the streets with a new-born baby. Somehow she will find the cash.
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