Church agencies battle spread of HIV from mothers to babies

Dec. 1, 2005

By Kathy L. Gilbert*

Mena Damodharan became a bride at 19 and a mother at 20, but she probably won’t live to celebrate her child’s 7th birthday.

The marriage that was supposed to save her became a death sentence after she became pregnant and found out her husband had AIDS. The doctors at Christian Medical College in Vellore, India, were able to save Damodharan’s child from contracting AIDS, but they do not have the drugs or money to save her.

Through the United Methodist Committee on Relief and the United Methodist Board of Global Ministries, critical work is being done to save the next generation from being born with HIV. But the question of saving the mothers so they can raise their children is still a struggle, says Cherian Thomas, an executive with the health and relief unit of the board.

Saving the babies

The use of the drug Nevirapine has been shown to dramatically increase the chances a baby will be born without AIDS, Thomas says. The board has been trying to start programs that encourage the use of Nevirapine in several countries.

A workshop on the drug’s benefits was held in Zimbabwe two years ago, and as a result, a Canadian agency based in Harare agreed to fund the work at three United Methodist hospitals in Zimbabwe — Nyadire, Old Mutare and Mutambara.

The United Methodist Chicuque Hospital in Mozambique has also used Nevirapine but has had to suspend the program because the drug is not available from the government at the moment, says Jeremias Franca, hospital administrator. In Mozambique, the government controls all drugs, and there is no private health care.

“Nevirapine will not be available for the rest of the year,” Franca said. “The government has promised a good supply, and we hope to start the program again without stopping in January.”

“There is a 30 percent chance that an infected mother will transmit the virus to her newborn, and this is halved when one dose of Nevirapine is given to the mother at the time of delivery and one dose to the baby after birth,” Thomas said. “The rate is reduced further if Nevirapine is combined with AZT.”

In 2004, around 640,000 children under 15 became infected with HIV, mainly through mother-to-child transmission, according to recent reports from world health agencies. About 90 percent of these infections occurred in Africa. The AIDS crisis in India is growing and is second only to that in Africa.

The World Health Organization reports that in the absence of any intervention an estimated 15-30 percent of mothers with HIV will transmit the infection during pregnancy and delivery, and 10-20 percent through breast milk

In high-income countries such as the United States, mother-to-child transmission of AIDS has been virtually eliminated because of voluntary testing and counseling, access to antiretroviral therapy, safe delivery practices, and the widespread availability and safe use of breast-milk substitutes. If these interventions were used worldwide, they could save the lives of thousands of children each year, the World Health Organization reports.

At Chicuque Hospital, Jeremias Franca knows the importance of educating women about the risks of AIDS and pregnancy.

“We want to mobilize pregnant women to come in for testing,” Franca said. “But the dilemma then is once the baby is born, what happens next?”

Once the baby is born, the chances are high that it will get AIDS from the mother’s breast milk, he said. Mothers are not encouraged to use baby formula because “we know they will not use it.”

“Now you have two people needing AIDS treatment; these are the things we are dealing with.Only prayer can answer these questions.”

Thomas said in many countries such as Mozambique the lack of safe drinking water gives mothers no choice other than breastfeeding. “If you give the baby water that is contaminated, then the baby gets diarrhea and dies.”

“Most people do advocate breastfeeding,” he said. “In Africa, there is a stigma that after you give birth and you do not breastfeed and you use formula that means you have HIV, so mothers don’t want to do that either.”

An initiative that was launched on World AIDS Day two years ago — Dec. 1, 2003 — to provide antiretroviral treatment to 3 million people living with AIDS in developing countries by 2005 has not been met, Thomas said.

“Just about a million are being treated, and 2 million are not getting the drugs at all. That includes women who are HIV-positive,” he said. “I don’t see any immediate solution.”

The annual report published by the Joint United Nations Programme on HIV/AIDS and the World Health Organization found, despite decreases in the rate of infection in certain countries, the overall number of people living with HIV has continued to increase in all regions of the world except the Caribbean.

In 2005, there were 5 million new infections. An estimated 40.3 million people, up from 37.5 million in 2003, are living with HIV globally. More than 3 million people died of AIDS-related illnesses in 2005; of these, more than 500,000 were children.

Once the drugs are administered, a certain amount of follow-up needs to be done, and that is “pretty weak in Africa and in other countries where the virus is rampant,” Thomas said. “Basic infrastructures need to be improved.”

Chicuque has recently built and devoted extra space to testing, educating and counseling pregnant women with AIDS. Once a woman tests positive, Franca said, she is put on a program to receive treatment for the rest of her life.

“Counseling before testing, post-testing when they test positive … all this takes a long time,” he admits. Another complication in Mozambique at the moment is a drought that is making it difficult for people to get basic nourishment.

“We have on average 165 births a month, and the numbers are increasing,” he said. “We also have a program of distributing mosquito nets to each newborn.” The program is not only preventing malaria, it is also encouraging women to come into the hospital to have their babies.

“I think it is good that we continue and get support on mobilizing many expectant mothers to come to the program. Many don’t come to the hospital for delivery. We need to get them to come to the hospital.”

Saving the mothers

Columbia University in New York is working on a program called MTCT Plus, Thomas said. The mother-to-child-transmission program advocates specialized care to HIV-infected women, their partners and their children.

The MTCT-Plus Initiative was established in 2002 to address the treatment and care of HIV/AIDS in resource-limited communities. It was created in response to the U.N. Secretary General’s Call to Action and coordinated by the Mailman School of Public Health at Columbia University.

This care includes a comprehensive list of services, including psychosocial, nutritional, and adherence counseling; peer support; infrastructure development; antiretroviral procurement; staff training; and monitoring and evaluation services. MTCT-Plus supports 13 sites in nine countries in sub-Saharan Africa and Asia, with more than 8,000 individuals enrolled in HIV care and treatment to date.

For women like Damodharan, help is needed soon. Her grandmother gave her in marriage as a second wife to a man she thought would look after her. The man knew he was HIV-positive when he took Damodharan as his wife, doctors at Christian Medical College said.

“We did a Caesarean section and followed up with the baby, who was born negative,” said Dr. Jessie Lionel. The doctors are trying to help Damodharan, her grandmother and the baby by giving them their own money.

A neonatal service and scholarships for Christian Medical College are supported by the United Methodist Church’s second-mile giving program, the Advance for Christ and His Church, through the Board of Global Ministries. Donations can be made by check and designated for Advance #12435 or #09952.

Contributions to Chicuque Rural Hospital may be sent through a local United Methodist church, annual conference or by mailing a check to Advance GCFA, P.O. Box 9068, GPO, New York, NY 10087-9068. The check should be written to “Advance GCFA” and designated for Chicuque: Hospital Revitalization, Advance #09734A on the memo line. Call (888) 252-6174 to give by credit card. For more information visit the Advance Web site gbgm-umc.org/advance.

Global AIDS Fund

The United Methodist Church wants to raise $8 million in the next four years — $1 for every U.S. member — to help fight the global HIV and AIDS pandemic.

A resolution passed by the 2004 General Conference, the denomination’s legislative assembly, called for the creation of the United Methodist Global AIDS Fund to be used to support programs offering HIV and AIDS education, prevention, treatment and care services in the United States and around the world. The resolution also established the Global AIDS Fund Committee to oversee the fund.

AIDS is the fourth leading cause of death in the world. Seventy percent of the estimated 40 million people living with HIV are in sub-Saharan Africa. About 600,000 children each year are infected, and 14 million have been orphaned due to parents dying of AIDS.

Anyone interested in giving to the Global AIDS Fund can contribute through their local United Methodist church or send gifts to UMCOR Advance #982345 Global AIDS Fund, P.O. Box 9068, New York, NY 10087-9068. Credit-card donors may call (800) 554-8583. One hundred percent of contributions will go directly to AIDS programs.

*Gilbert is a United Methodist News Service news writer based in Nashville, Tenn.

News media contact: Kathy L. Gilbert, Nashville, Tenn., (615) 742-5470 or newsdesk@umcom.org.

Video Story

Women With AIDS: Hospital helps infected mothers

Small United Methodist clinic serves large population with AIDS

Visit to orphan's house inspires an AIDS ministry in Zimbabwe

HIV-infected women march on AIDS Day

United Methodist AIDS committee aims to raise $8 million

Resources

World AIDS Day 2005

Global AIDS Fund

HIV/AIDS Ministries