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PPTCT as an entry point to AIDS care in Africa
Women and AIDS Support Network (WASN)
September 30, 2002

With advances in science and technology that have seen the discovery of drugs such as Nevirapine and Zidovudine (AZT), which reduce vertical transmission of HIV, has come many arguments for and against prevention of parent-to-child-transmission (PPTCT) of HIV.

Opponents of PPTCT have argued that the drugs are toxic, result in an increase in the number of orphans and use women as safe passages to deliver healthy babies, while neglecting the mothers and offering nothing tangible to sustain or prolong their lives.

However, proponents of PPTCT argue that this could actually be the entry point to AIDS care in Africa.

According to Ugandan AIDS activist, Millie Katana, PPTCT ought to be used as an entry point to achieving everything else that activists have failed to get in their fight for treatment and care.

Outlining the benefits of this strategy, Katana predicts that PPTCT will help to reduce infections by about 25 percent by the year 2004. Further to this, it will significantly reduce denial and ostracism among people with HIV/AIDS.

In addition, it has helped to break ground for treatment by making people realize that drugs are part of treatment. Furthermore, there is an increase in awareness on how to deal with HIV.

She further argues that PPTCT has opened ground for testing with rapid tests that are widespread being available where there were not Voluntary Counselling and Testing (VCT) facilities in the past.

"For people who used to ask, what’s in it for me if I get tested, the fact that they want to protect their babies has been reason enough to test," she says, adding that PPTCT has also reduced fear of infection to babies.

Because the regimen, Nevirapine, is simple to use, people who are not specialists can administer it. This has helped to prove that AIDS treatment is not as complicated as the opponents of treatment have tried to make it seem. Those who are opposed to giving Africans treatment have often argued that Africans cannot follow instructions and cannot tell when it is time to take their medication. However, successes in the use of PPTCT have disproved such claims.

Countering the argument that PPTCT will increase the number of orphans when their mothers die of AIDS, Katana states that there are now some new programmes called Prevention of Parent-to-child-transmission (PPTCT) plus, which make treatment accessible to the mother. As a result, she says, many African governments are beginning to include treatment in their budgets.

Citing Uganda as an example, Katana says that the country has allocated money for the treatment of mothers and children who are HIV positive.

In support of Katana’s views, a South African medical practitioner who declined to be identified, says that it is important to have a PPTCT programme because it allows doctors to diagnose women while they are still healthy. This enables people living with HIV to start looking after themselves early by adopting healthy lifestyles, rather than wait and discover their status when they are sick and have to go on antiretroviral treatment.

It has also been noted that mothers who give birth to negative children are likely to find that as an inspiration to take better care of themselves so that they can live long enough to look after those children. The child, it has been argued, is enough to give the mother a reason to live.

However, despite the strides that have been made and the benefits that can be realised in treatment as a result of PPTCT, Katana says there is still need for a lot of work to be done around the issue.

First, she says, there is need to intensify prevention campaigns as reducing transmissions means existing resources will not be over-stretched. As a result of this, the resources allocated to treatment can then be focused on the existing infected.

"What happens when you have many children and one piece of meat is that you have to give each child a small piece, but if you have less children, the few can get larger portions," she said, adding that the same applies to resources allocated to treatment of HIV.

In addition, Katana says many People Living with HIV/AIDS (PWA), are not aware of existing treatment options and there is need to conduct a massive treatment literacy exercise so that such people can begin to benefit from the use of these drugs.

Further to this, she says, some medical practitioners lack information about HIV treatment and there is need to educate them on this.

"Some medical practitioners’ only knowledge of communicable diseases is malaria," she jocularly adds.

Concluding her views, Katana calls for a total paradigm shift from mere rhetoric to action that will bring real results.

"We have done everything else during the past 20 years, we need to make AIDS care and treatment part and parcel of the AIDS intervention," she says.

However, in both the battle for PPTCT and access to treatment and care, Katana says there is need to justify why people need treatment and this can be done by justifying the cause for saving lives.

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