Back to Index

Keep our children safe
Zvitambo Project
2003

Listen to interviews with HIV+ mothers

Story of the film:
Jane and Mercy live in a rural area of Zimbabwe. Both are pregnant. Jane encourages Mercy to attend the local hospital antenatal clinic and have an HIV test.

Jane's previous baby died, possibly from AIDS. But since neither she nor the baby had been tested, she never knew for sure. This time she's taking the test so she can find out before the baby is born.

The two friends learn a lot from each other, and from the nurse at the clinic. They find out about HIV and how they can reduce the chance of infecting their babies. Garikai, Jane's husband joins her for counselling. Both are HIV positive.
Facing it together turns out to be much better than worrying about it secretly.

Target audience:
this film is intended to help pregnant women understand the most important issues involved in the transmission HIV from mother to child. It could be shown to:

• Mothers coming to the antenatal clinic
• Women living in "Waiting Mothers Shelters"
• It will also be of great value to the wider community, including men, and
• Health Care Workers as part of their training in 'PMTCT' work.

A Health Care Worker who has been trained in PMTCT should be always present when this film is shown, in order to answer questions and clarify misunderstandings.

Issues that may come up:

Children who have been sick and /or died
Of course this not necessarily because of HIV. If the mother is HIV positive it is much more likely. There are some typical clinical symptoms and signs of HIV disease in children. These should usually be discussed on an individual basis ( to avoid patience making their own diagnoses ). They include:

• Failure to thrive
• Recurrent infections including pneumonia (severe ARI) and diarrhoea.
• Many lymph nodes easily felt in different areas of the body
• Large liver and /or spleen
• Oral thrush
• Loss of developmental milestones already acquired

Of course any of these can happen without HIV infection, so it is very important that the mother is tested for HIV. The baby can only be infected if she is positive.

Do Mothers and babies share their blood during pregnancy?
No. In the placenta the two blood systems are very closely intertwined like the fingers of your two hands put between each other ).

Good things (like oxygen and nutrients) pass across the thin barrier from the mother to the baby and waste products pass from baby to the mother. Occasionally an infection (like syphilis or HIV) can pass from the mother to the baby though this is uncommon. 5-10% (1-in-10 to 1-in-20) HIV positive mothers will pass HIV infection to their babies across the placenta.

You can look at it like this :
Of 10 HIV positive mothers, about two will pass the virus to their babies before or during delivery. If they are breastfeeding then about 1 mother in 10 will pass it to her baby in the breast milk. This is without a PMTCT program in place - with nevirapine and safer breastfeeding, transmission can be reduced by half.

To the health worker: You can demonstrate this more accurately by drawing 100 circles for HIV+ mothers.

Without a PMTCT program about 7 will pass the virus to their babies before delivery, and 15 during delivery. If they are breastfeeding for up to 2 years, then about another 15 mothers will pass it to their babies in the breast milk. 63 babies will not get infected. This is without a PMTCT program in place. With nevirapine and safer breastfeeding, transmission can probably be reduced by a half, and more than 80 babies will not be infected.

Nevirapine
Side effects have been reported, but these have only occurred when many doses of the drug have been used over a period of time, not in the way it is used in PMTCT with only 1 or 2 doses.

Resistance of the HIV virus to nevirapine have been found after a single dose but the resistant virus seems to disappear within a year or so. Therefore WHO and the Ministry of Health of Zimbabwe have decided that the benefits of nevirapine are greater than this theoretical small risk and the drug can and should continue to be used in PMTCT program work.

Husbands and other relatives
It is very good for husbands and other members of the family to be involved in the conversations and decisions of PMTCT. Hospitals and clinics should make every effort to involve them. However if a mother is happy to make her own decision, for example to be tested for HIV, that is ok.

Confidentiality
The conversation between the counsellor and his or her client is private and is not to be repeated to anyone. However HIV status is a medical finding like others and may need to be communicated to other health workers. For example nurses in the antenatal clinic may need to discuss a patient's HIV status with those working on Labour Ward. This is called "Shared Confidentiality" and is a normal part of the professional way in which health workers take care of their patients.

Breast milk substitutes
At present the Ministry of Health is not planning to provide infant formula to HIV positive mothers who do not want to breastfeed. Therefore the mother or the family who are considering different feeding options must decide whether they themselves can afford something other than breastfeeding. Of course the other considerations about Acceptability, Feasibility, Sustainability and Safety also need to be thought through.
Remember that, for HIV negative mothers and those who have not been tested, the best thing is to breastfeed exclusively for 6 months, and then to continue breastfeeding up to 2 years or more while introducing complementary foods.

The Health Worker showing this video should have easy access to the following booklets which will be useful in answering other questions which may come up.

Visit the Zvitambo fact sheet

Please credit www.kubatana.net if you make use of material from this website. This work is licensed under a Creative Commons License unless stated otherwise.

TOP