PANCAP News-in the caribbean

One child born with HIV is too many

In 2010 one baby in Antigua and Barbuda was born with HIV. That’s one too many for prevention of mother-to-child transmission (PMTCT) coordinator at the National AIDS Program, Everton Pigott. The solitary case still weighs heavily on his mind.

“I am still hurt up to this day,” he says with a sigh. “That situation could have been totally avoided.” Pigott’s lament points to a new truth about our battle with HIV. We now have the knowledge and tools to eliminate mother-to-child transmission. Before any interventions were available more than one-quarter of all babies born to HIV positive mothers in the Caribbean were infected. Those odds have steadily improved with HIV screening and the adoption of more effective treatment regimens. (See sidebar)

A regional Elimination Initiative aims to eradicate this form of HIV infection by 2015. UNAIDS Caribbean Regional Support Team Director, Dr. Ernest Massiah, has added that the Eastern Caribbean, with its smaller disease burden, can reach the target far sooner..

“We have the means to prevent this. It is simple. In 2012 no Caribbean child should be born with HIV,” he says.

Stakeholders are collaborating to ensure that this HIV response is fully and sustainably included in countries’ healthcare systems. Pigott indicated that in Antigua and Barbuda one priority is the decentralisation of HIV services so that women could access more of their treatment needs at community health facilities rather than all being steered to the solitary High Risk Clinic.

But beyond the nuts and bolts of the healthcare response are the abstract stumbling blocks of fear, shame and prejudice.  For PMTCT to work mothers must access antenatal care early, adhere to treatment, abstain from breastfeeding and make both themselves and their children available for subsequent care. For some, the fear of being discriminated against leads to them presenting late (or not at all) for prenatal care and not returning with their infants for follow-up.

“Some mothers—including non-nationals—are reluctant to come forward if they are HIV positive. They need to be reassured that we have ways and means to prevent transmission so they should come forward early instead of turning up at the hospital when the baby is about to be born. Our role is not to drive anybody away; it is to save lives,” Pigott stresses.

Carolyn Daley Lewis is one of the nurses attached to the antenatal clinic at the Mount St. John Medical Centre. She stresses that all women are encouraged to attend the clinic as soon as they discover they are pregnant so that they can be screened for the virus and, if positive, start treatment right away.  She says that making the case for testing is usually easy, though they do encounter the odd person with reservations.

“We encounter difficulty with all clients who think they might be positive and have not informed their partner, irrespective of their socio economic status. They tell you ‘nurse, suppose it comes out positive?’ Our job is to inform them about all the treatment and care options that exist. It’s no problem,” says Lewis with her enduringly soothing tone.

Pigott admits that the pervasive fear that one’s confidentiality might be compromised is a unique challenge in small island settings: “Antigua is a very small place.  Almost everybody knows everybody. These are some of the concerns we talk about with women. We try to emphasise that although I know your father it’s not for me as a healthcare worker to divulge that information to him. We do encourage them at some point in time to disclose so that they can have the support and care of their loved ones but that decision is entirely up to the individual.”

Lewis agrees that clients are often anxious about both healthcare workers and relatives learning that they are HIV positive.

“Some of them have this feeling of rejection. They think when they go to deliver the baby if a family member realises their status they will be neglected. We have to assure them that the nurses won’t let anybody know,” she says.
But what is the state of stigma and discrimination within the healthcare system itself? Have Antiguan health workers overcome their own anxieties and prejudices about caring for HIV positive patients?

“My observation is that there is not nearly as much stigma attached to HIV now as compared to the start of the epidemic.  From a nursing perspective we look at it as just another condition. People still need care and we must try to reach out to them as much as possible,” Lewis asserts.

Getting to zero cases of paediatric HIV lies in large part at the feet of reassurance and trust.

“There is no reason to feel fear or shame.  HIV is an illness,” Massiah says, “not a crime or a judgement.  As a people we have to move beyond that.” 

Find out more about prevention of mother-to-child transmission in the Caribbean as a whole, Cuba and other English-speaking countries in the region.