Low STI testing puts HIV-positive pregnant women at risk

While most pregnant women in Zambia are now tested for HIV, other sexually transmitted infections such as syphilis are not being diagnosed, placing the lives of thousands of women at risk.



By the time Emily Banda*, 31, found out she had syphilis, it was too late – her daughter had died at five months and she had a miscarriage during her second pregnancy.



Banda was only tested for HIV and syphilis after her divorce, when she had moved from the small town of Kalabo in Western Province to the capital, Lusaka.



“At the hospital, they counselled me and tested me... There were no signs that I had syphilis and the doctor said I had [had] the problem for a long time,” she told IRIN/PlusNews.



A study conducted in Uganda and Zambia by the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) – identified high rates of syphilis and HIV co-infection in pregnant women in both countries. In Uganda, 14.3 percent of syphilis-positive pregnant women also tested positive for HIV, and the rate was 24.2 percent in Zambia.



High co-infection rates of syphilis and HIV in pregnant women increase the risk of HIV transmission from mother-to-child. Like HIV, syphilis is a major cause of morbidity and mortality among women and children in developing countries. The HIV prevalence rate among pregnant women in Zambia is about 19 percent.



According to Susan Strasser, EGPAF country director for Zambia, syphilis testing should be part of the routine pre-screening done for pregnant women, but is often missed.



“In Zambia, if we're going to be successful in eliminating paediatric AIDS, we have to also prevent congenital syphilis,” said Strasser, co-author of the study. “Congenital syphilis can be easily diagnosed and cured thanks to rapid diagnostics and treatment. It is simply unacceptable for this disease to continue to plague women and children.”



The EGPAF study found that integrating rapid syphilis screening and HIV testing for pregnant women was feasible, cost-effective, and helped to prevent transmission of syphilis and HIV from mother-to-child. Rapid syphilis tests were introduced in antenatal clinics that provide services for the prevention of mother-to-child transmission (PMTCT) of HIV in Uganda and Zambia. The new tests make it possible to screen more pregnant women for syphilis in a variety of urban and rural settings without the need for additional laboratory equipment or refrigeration.



Rapid syphilis testing is now as simple as a malaria test, Strasser noted. “You can simply take blood with a needle from a vein or finger prick and then you take the blood on the slide, much like a rapid malaria test or rapid pregnancy test and then you have the results after 20 minutes,” she said.



A regular syphilis test, on the other hand, has to be carried out “by someone who is highly trained; it needs electricity and it is usually done in batches”.









''In Zambia, if we're going to be successful in eliminating paediatric AIDS, we have to also prevent congenital syphilis ... It is simply unacceptable for this disease to continue to plague women and children''

“A woman would have the blood drawn for testing and then she will be told to come back in the afternoon for the results or even the next day and... when they go home to tend to [their] responsibilities, they don’t come back to get the results and subsequently, they don’t get treated.”



Stigma and lack of support from their male partners also prevents many pregnant women from accessing treatment, Mulemi Kayumbwa, a clinical officer at Kalingalinga Hospice in Lusaka, told IRIN/PlusNews.



“We make sure that syphilis-positive pregnant women are encouraged to notify their husbands, so that they are all treated at the same time,” said Kayumbwa.



During the study, EGPAF collaborated with the Centre for Infectious Disease Research in Zambia to pilot the use of a partner invitation slip to encourage partners of syphilis-positive pregnant women to visit the antenatal clinic for HIV and syphilis testing and treatment services.



The study’s findings convinced Zambia’s health ministry to include rapid syphilis testing in its standard package of PMCT services and antenatal care, said Ministry of Health spokesperson, Reuben Kamoto Mbewe. “Every woman who goes to the clinic for antenatal is tested for syphilis. It is now mandatory.”



*not her real name



cm/kn/mw