New Vision (Kampala) - November 9, 2005
Hilary Bainemigisha

YOU are pregnant! Praise God. The whole family is excited. You don't want anything to go wrong. But it does! You are HIV positive and your husband is too! The idea of 'killing your own child' haunts you, so does the fact that your property will be inherited by 'foreigners' and your name will die forever!

Alice Bakunda, a psychosocial support officer and counsellor at Mildmay, an HIV/AIDS management centre at Lweza, Entebbe Road, says this is one of the challenges HIV counsellors face.

Expecting parents are very delicate in coming to terms with AIDS.

According to Dr William Musoke, a senior medical officer at Mildmay, chances of passing HIV to your baby are 30% His colleague Dr Monica Etima, a paediatrician, says about six to 15 out of every 100 pregnant women are found HIV positive at Ugandan antenatal clinics. "In sub Saharan Africa, 90% of about 660,000 HIV positive children (less than 15 years) were believed to have contracted HIV from their mothers during pregnancy, on delivery or during breastfeeding," she said.

The chance for your innocent child to escape this scourge depends on you parents. Mother-to-child transmission Etima says mothers may transmit HIV to their babies in three ways: During pregnancy (in-utero) This accounts for about 20% of the total transmission, especially in the later months. The uterus is well designed to filter dangerous elements from a mother, and preventing them from reaching the foetus. However, some factors may undermine this protection:

• Diseases such as malaria and sexually transmitted infections (STIs) especially syphilis which damage the placental barriers

• Poor nutrition of the mother which is associated with increased HIV transmission

• The stage of HIV infection: According to Dr Emmanuel Luyirika, Mildmay director of clinical services, the viral load is very high in the first six weeks of getting infected. Likewise, when the mother is at the stage of AIDS, chances of infecting the baby are high. However, the mother can have her baby infected at any stage.

During labour and delivery

• This is the most dangerous phase accounting for 60% of the infections because of the following factors: The baby is exposed to plenty of the mother's infected blood and body fluid secretions teeming with the virus.

• When the delivery is carried out without a trained health worker.

• Use of contaminated instruments during delivery

• Prolonged rupture of membranes.

• Excessive bleeding during delivery.

• In the unfortunate case of premature birth.

During breastfeeding

• This makes up 15% - 20% of the infections, usually in the first three months but extends for as long as the child is exposed to the breast milk. It is also subject to certain factors If the mother got infected within the past six months

• Prolonged breastfeeding

• Mixed feeding because weaning introduces foods that inflame the gut, undermining its protective layers.

• Poor breastfeeding conditions or sores, cuts, infections and abscesses on the breast, especially the nipple

• Absence of anti-retroviral treatment (ARVs) at all stages. Hope for parents Etima says parents play the biggest role in ensuring their child is protected from HIV. The ideal thing should be for partners to go for an HIV test before they can decide to have a child. However, if you are already positive, Etima suggests the following precautions: Use of Nevirapine. This is a potent anti-retroviral agent which causes a rapid drop in the viral load. It stays in the blood for a long time and studies show it does prevent babies from getting HIV by 47%.

• The mother should start this prophylatic ARV at the onset of labour and the baby too immediately after birth within 72 hours.

• Comprehensive antenatal care. At the Prevention of Mother To Child Trans-mission (PMTCT) centres, quality antenatal, intranatal and postnatal care is available.

• Routine check up for malaria and syphilis

• Modified obstetric care, where midwives treat the whole process with utmost care. For example, they should cut the umbilical code with maximum care to avoid exposing the baby's naval wound to the mother's blood.

• Safe infant feeding. Either the mother does not breastfeed the baby at all or she does exclusive feeding (breast milk without any other foods) for not more than six months.

The parents must ensure good nutrition, avoid stress, fatigue and exhaustive lifestyle.

Etima advises that should you succeed and get your child through as HIV negative, do not be tempted to become pregnant again.

"Continue with ARVs, and live positively. But if you conceive, make sure the baby gets this ARV so that it does not join the 66% of HIV infected children in Uganda, who do not celebrate their third birthday.

"Despite presence of PMTCT programmes, some children still get HIV. However, there is hope with the present use of other ARV for improved survival and quality of life of such children", she said.

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