By Joyce Chimbi
Motivated by her life experiences – having been infected with HIV/Aids at 19 years, diagnosed with the virus at 29 years, and delivering her first baby at 32 years who later passed on six months later from pneumonia in 2009 – Margaret Odera was determined to live and be a symbol of hope to HIV positive pregnant and breastfeeding mothers.
Her journey as a peer educator, Community Health Worker (CHW) and mentor mother started in 2009 at Mathare North Health Center in Nairobi. She first entered the facility as a client and never left. Odera works with the facility as an integrated CHW and a champion for the Prevention of Mother to Child Transmission (PMTCT) of the HIV/AIDS program.
“In 2009, I was dismayed and in shock at what I saw in the community. More than 80 percent of HIV-positive pregnant women gave birth in the hands of traditional birth attendants (TBAs). The HIV positivity rate from mother to child was at least 98 percent. These mothers refused ARVs and embraced herbal concoctions,” she explains.
“The mothers believed that they were bewitched and ran to traditional medicine men, their immunity was very low and there was no escape for their babies who were vulnerable during pregnancy, birth and breastfeeding. While their HIV-positive babies wasted away, they claimed that the babies had been looked upon with a ‘bad eye’ or bewitched.”
Today, the positivity rate at Mathare North Health Center, or the rate of HIV transmission from mother to child is less than one percent. The journey toward the Elimination of Mother to Child Transmission (EMCT) of HIV was shared by Dr Caren Mburu from Elizabeth Glaser Pediatric AIDS Foundation who said that overall, mother-to-child transmission has fallen from 16 percent in 2016 to 8.6 percent in 2022.
Odera is among the HIV-positive mothers who have managed to deliver, breastfeed and raise HIV-negative children. As a peer educator and mentor mother, “my duties are more specialized and specific because here I speak about an experience that I have gone through. I am an HIV-positive mother of three HIV-negative boys. One boy was born in 2013 and twins were born in 2017. My husband is HIV-negative. I use my story to inspire others that discordant relationships work and elimination of mother-to-child transmission of HIV is possible.”
Speaking to a group of science and health journalists from the Media for Environment. Science, Health and Agriculture (MESHA) at a Media Café organized in partnership with the National AIDS & STI Control Programme (NASCOP) in Nairobi, Dr. Caren Mburu, Elizabeth Glaser Pediatric AIDS Foundation, said that it is possible to eliminate mother-to-child transmission of HIV.
HIV exposure in an infant or child can occur in utero, at labor and delivery and through breast milk. Even though HIV can be transmitted from an HIV-positive mother to the baby during pregnancy, delivery and breastfeeding period, being on ART and having an undetectable viral load during pregnancy and throughout breastfeeding significantly lowers the risk of passing HIV.
Research has shown that the risk could go as low as less than one percent. All HIV-exposed infants (HEI) should be tested for HIV within six weeks of age or at first contact with a health facility; if negative then another test should be administered at six months, and if negative then repeat the HIV test at 12 months.
The HIV testing in infants should be done using the HIV DNA polymerase chain reaction (PCR), a highly sensitive and specific method to detect the presence of HIV in infants, as it looks directly for HIV in the blood.
On the current Kenya HIV landscape with regard to children, adolescents and young adults, Dr Mburu said that “currently, 68,000 children aged 0 to 14 years are living with HIV. In addition, 88,853 adolescents aged 10 to 19 are living with HIV. Overall, 145,142 youth and young adults aged 15 to 24 are living with HIV.”
According to the Kenya HIV Prevention and Treatment Guidelines 2022, “prevention of mother-to-child transmission of HIV, Syphilis and Hepatitis B virus (HBV) which is referred to as the triple elimination should be offered as part of a comprehensive package of fully integrated, routine antenatal care interventions.”
All pregnant women, unless known positive, should be counseled and tested for HIV, Syphilis -using the HIV-Syphilis dual test- and HBV during their first ANC visit, and if negative a repeat HIV-Syphilis dual test should be performed in the 3rd trimester. Lifelong ART should be initiated in all pregnant and breastfeeding women living with HIV, regardless of gestational age, WHO clinical stage or CD4 count.
Despite the many challenges along the journey towards elimination of mother-to-child transmission of HIV, Dr Mburu stressed that there has been tremendous progress. For, HIV prevalence has gradually dropped from 5.6 percent to 3.7 percent in 2022. New HIV infections among children 0 to 14 years dropped from 16,000 to 4,500 in 2022 and AIDS-related deaths among children 0 to 14 years fell from 14,000 in 2010 to 2,300 in 2022.