Limited response to PMTC programme

Zimbabwe's efforts to prevent the transmission of HIV from mothers to their children is being undermined by a limited response to the initiative, the head of the programme, Dr Agnes Mahomva, told a national AIDS conference this week. The government rolled out the first phase of its prevention of mother-to-child transmission (PMTCT) programme in 2002. Currently, out of the 53 district hospitals in the country, 43 have started administering free single doses of the drug Nevirapine - which can reduce transmission of the virus by more than half - to HIV-positive expectant mothers. "The uptake in the programme has been disappointing. In 2002 only 35 percent of the identified mothers [in specific sites] came forward for the programme. For 2003 the uptake increased to 56 percent, but the numbers of children who came for follow-up programmes is 29 percent," said Mahomva. Children who have received Nevirapine are expected to be tested for HIV after 18 months. The limited response by HIV-positive expectant mothers appears to be rooted in the fear of stigma and discrimination. "If I stop breast-feeding, I have to explain to my relatives and my husband. I have to disclose my status. I know women who were beaten or divorced just for disclosing their HIV status to their husbands," explained Veronica Mutsumwe, a delegate at the conference. "If there is a chance my child can survive without the programme, I would rather not take part in it than face the wrath of my husband and his relatives." Another challenge for the programme has been the issue of community mobilisation and male involvement. In all the sites providing PMTC, only 4 percent of men with HIV-positive partners took advantage of counselling services. "Involving male partners has been also a major challenge in the national problem. We acknowledge that this may be a result of the structures in our services, which are not conducive to male participation, and we are working on this," said Mahomva. A related problem has been the brain drain that has affected Zimbabwe's public health system as a whole, robbing the programme of trained councillors. "There is limited counselling in antenatal sites and this is a major problem for PMTCT clients," Mahomva noted. Poverty and Zimbabwe's food security crisis have also played a role. "What's the point of making my child well if I am going to die? I do not even have sufficient food, yet they want to save my baby," said Mutsumwe. More than 700 delegates are attending the first national conference on HIV and AIDS. The theme of the three-day gathering is "Taking Stock: Looking into the Future".