In Mozambique, A Fight To Keep Babies HIV-Free In one province of the southeastern African nation, 30 percent of women are HIV-positive. Pregnant women who seek prenatal care are routinely tested for the virus and, if infected, will be given anti-retroviral drugs to help prevent transmission to their babies. But drug shortages are preventing some women from getting the help they need.
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In Mozambique, A Fight To Keep Babies HIV-Free

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In Mozambique, A Fight To Keep Babies HIV-Free

In Mozambique, A Fight To Keep Babies HIV-Free

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From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris.


And I'm Melissa Block.

This summer, we're airing a series of stories about women and childbirth around the world. And today, I have the last of three reports from Mozambique in southeastern Africa; a story about efforts to prevent mother-to-child transmission of HIV.

I've come to the hot zone for HIV infection in Mozambique, Gaza Province, where 25 percent of those aged 15 to 49 are HIV-positive. Among women in Gaza, that number is even higher, 30 percent are infected with HIV.

Ms. CELESTINA MATAVEL (Nurse): (Foreign language spoken)

BLOCK: At this health clinic in the town of Macia, 24-year-old Adelia is about to get an HIV test. She's wearing a stylish grey suit with a shiny alligator print handbag. Adelia is about five months pregnant. And if you come here for prenatal care, as she has, you will get tested for HIV.

(Soundbite of ripping packages)

BLOCK: Nurse Celestina Matavel rips open the test kit, making sure the young woman notices it's a new kit just for her, so there's no danger of contamination.

Ms. MATAVEL: (Foreign language spoken)

BLOCK: A finger prick, a drop of blood on the narrow test strip and a short, anxious wait. The nurse and patient bow their heads closer to the strip, as two faint red stripes emerge.

ADELIA: (Foreign language spoken)

BLOCK: I'm positive, Adelia murmurs. A second test confirms the result. She is HIV-positive with a baby due in the fall. She presses her lips together and gets a faraway look, as the nurse urges: Don't be scared.

Ms. MATAVEL: (Foreign language spoken)

ADELIA: (Foreign language spoken)

Ms. MATAVEL: (Through Translator) Relax. HIV doesn't mean you're dead, don't dare lose strength. You'll live your life the same way. When you get malaria, don't you come to the hospital? Don't you take medication? Don't you live?

ADELIA: Mm-hmm.

Ms. MATAVEL: (Through Translator) It's the same as this. Don't think your life is going to change.

Dr. NANCY FITCH (Director, Elizabeth Glaser Pediatric AIDS Foundation): (Foreign language spoken)

BLOCK: That's an American doctor, Nancy Fitch, telling Adelia: If you take your medication, your baby will be okay.

Dr. FITCH: (Foreign language spoken)

BLOCK: I have a lot of hope for you and your child, Fitch tells Adelia. You can have a normal life and your child can, too.

Dr. FITCH: (Foreign language spoken) Courage, okay?

ADELIA: Thank you.

BLOCK: Dr. Fitch has brought us to this clinic. She's country director for the Elizabeth Glaser Pediatric AIDS Foundation in Mozambique, which helps fund the work here.

Adelia will be put on anti-retroviral drugs through the last months of her pregnancy and through breast-feeding, so she doesn't pass HIV on to her baby. The newborn will be also be given the drugs.

Adelia will be advised to breastfeed exclusively for six months, something that's not part of the protocol in the West. But in developing countries it's believed that the benefits outweigh the risks. If Adelia can stay with the regimen, the chance of her baby being infected can be reduced to about five percent, down from 30 to 40 percent if she were to do nothing.

Outside, Dr. Fitch looks around at the hundreds of women waiting patiently, many of them HIV-positive with HIV-positive children.

Dr. FITCH: Here, you're probably in one of the places where one is most inclined to feel overwhelmed.

(Soundbite of children crying)

BLOCK: She says the AIDS epidemic has reversed the steady progress Mozambique had made in reducing the mortality of children.

Dr. FITCH: In the last 10 years in Gaza, the impact of this epidemic has just been terrible. So, here in Gaza, you're at a place where you really feel it's in your face, yeah.

BLOCK: And Dr. Fitch knows the women here are confronting harsh realities.

Dr. FITCH: Babies in the past, if you had an HIV-positive baby, they would just - it's easier to let the baby die, rather than take on a commitment to feed an extra mouth and make all these trips to the doctors and stand in line one day a month waiting for medication. It's a burden that a family on the edge could probably not afford.

BLOCK: Do you think that's still the case?

Dr. FITCH: Absolutely. Not everywhere and there's definitely progress being made but on a day-to-day level, when you come here and you see the effort that needs to be made, it seems really hard sometimes.

BLOCK: Nearly all of the money to run this clinic for the drugs and test kits comes from international donors, the global fund set up to fight aids, and the U.S. government's fund called PEPFAR. In fiscal year 2010, PEPFAR's budget for Mozambique totaled nearly $270 million. That's more than what Mozambique contributes to its entire health care system.

Even with all of this outside aid, about a third of pregnant women in Mozambique known to have HIV aren't getting the drugs to prevent transmission.

Lucrecia Silva has brought her 15-month-old daughter, Helena, into the clinic. Helena wears a tiny soccer sweatshirt over her turquoise tulle dress. Both mother and daughter are HIV-positive.

LUCRECIA SILVA: (Foreign language spoken)

BLOCK: Lucrecia is picking up a month's supply of free anti-retroviral drugs for her baby. The drugs will slow the progression of the disease. Without treatment, half of all infants infected with HIV will die by their second birthday. If Lucrecia can't find a ride to the clinic she'll walk, two hours each way.

Tell me about your hopes for Helena here?

Ms. SILVA: (Foreign language spoken)

BLOCK: She tells me: I want her to lead a good life, to be healthy, and I want to live a long life.

Lucrecia's story is one I heard over and over, and it illustrates just how the virus spreads. Many men in Gaza Province, like Lucrecia's husband, go to South Africa to work in the mines. They're away for long stretches. Prostitution is rampant and so is HIV. They bring the virus home to their wives.

(Soundbite of singing)

BLOCK: A Sunday morning service at a Presbyterian church in the village of Malehice. It's a small, square structure made out of thatch with sunlight filtering through. The women and children sway as they sing.

Except for the pastor, there are no men here. They're either working in South Africa or just don't come.

(Soundbite of singing)

BLOCK: I meet one of the pastor's daughters, Acacia Navete Mukambe. She's slim and delicate, with a radiant smile. Her 16-month-old daughter, Virginia, dozes through the service in a sling on her mom's back. Acacia also has an eight-year-old son, Muianga, who's so tiny he looks about half that age.

Ms. ACACIA NAVETE MUKAMBE: (Foreign language spoken)

BLOCK: Acacia's husband works in the mines in South Africa. She tells me he got very sick and tested positive for HIV in 2007.

Acacia, how do you think your husband got HIV?

Ms. MUKAMBE: (Through Translator) I don't know where he got it. Now so many people have that disease, so I didn't give him a hard time about it. It's possible that he got it from me, but he went to get tested first. So that's why I didn't give him a hard time about it.

BLOCK: Acacia's husband urged her to get tested but she waited. She was scared and worried she'd be shunned. She got very sick and terribly thin. It wasn't until she was pregnant with Virginia that she finally had the HIV test. It was positive.

Ms. MUKAMBE: (Foreign language spoken)

BLOCK: Now with drugs that fight HIV, her health has improved. She's gained some weight and her daughter, Virginia, has tested negative. But Acacia faces a problem that's common in Mozambique.

Because of drug shortages or stock-outs, sometimes she can only get one week's supply of pills, not the whole month's worth. This is a big problem in rural areas like this one, where just getting to a clinic to pick up the drugs can take hours, by foot or bike.

If you make people come back more often to get their drugs, chances are they'll fall off the regimen and they'll get sick.

As her children, Muianga and Virginia, play nearby, Acacia talks about her fears for their future.

Ms. MUKAMBE: (Through translation) Since I have HIV, I'm scared of dying and leaving my children while they're still very young. But if the medicines really work, I'm not going to die of HIV, I'm going to die of everyday illnesses.

(Soundbite of singing)

BLOCK: After church, Acacia and the other parishioners gather in a circle outside, and her face lights up as she sings these words: Praying is what gives you hope. I will not go back. I must go forward.

Unidentified People: (Singing in foreign language)

BLOCK: Our stories from Mozambique were produced by Andrea Hsu.

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