Women driving progress to eliminate mother-to-child HIV transmission

Two months after giving birth to her third child, Orpa Adhiambo tested positive for HIV/Aids. Unfortunately, she had transmitted the virus to the newborn.

Due to fear of reliving the pain of seeing her baby’s health deteriorate and die a year later, Ms Adhiambo swore never to conceive again. This was despite the fact that she was then only 23 years old and her husband yearned for a male child.

"My baby suffered a lot. She grew weaker by the day and lost too much weight. I was even afraid of walking around with her due to fear of what people would say," says Ms Adhiambo.

She narrates that when she learnt she was pregnant with the third child in 2006, it was a time of anticipation as Ms Adhiambo and her husband hoped she was carrying a baby boy. However, after her first hospital appointment, she never visited any health facility for routine antenatal clinic (ANC).

When she started experiencing intense labour pains one Monday morning, Ms Adhiambo packed a few baby essentials and made her way to the homestead of a traditional birth attendant (TBA).

“My first two daughters had been born at the same place under a mango tree. I did not doubt that my third born child would also be delivered safely under the TBA's care.”

The baby, also a daughter, was born healthy. However, the couple got worried when the newborn started growing weak while her weight kept declining.

“A medical test at one of the sub-county health facilities confirmed that the baby and I were both HIV positive,” says Ms Adhiambo.

She left the health facility heartbroken, unaware of how to live with the guilt of infecting the innocent child. Her other worry was how to relay the message to her husband.

“The health facility asked me to come with my husband the next day. It was during the counseling session that my husband broke news that he was also positive. I learned that despite knowing his status, he was not on antiretroviral (ARVs) due to fear of stigmatisation,” she says.

They were all placed under antiretroviral drugs. Sadly, the newborn died a couple of months later. Devastated, Ms Adhiambo vowed never to have another child

But in 2020 at the age of 38, she delivered a healthy baby boy, who tested negative for HIV. She says her decision to have the baby had been inspired by a health talk at one of the women's support groups in Homa Bay County.

Ms Adhiambo was invited to Ringa Women’s Group by one of its members during a discussion on mother-to-child HIV transmission.

The group had also invited a health expert and a community health worker, who took them through a question-and-answer session, responding to all their concerns.

“When I went back home, I had a discussion with my husband after which we proceeded to the nearest health center for further guidance,” says Ms Adhiambo.

To have a healthy baby, Ms Adhiambo recalls attending her first ANC during the first month of her pregnancy. She was educated on the importance of adherence to ARVs and attending at least eight ANC clinics.

Unlike her two older children who were born at home, Ms Odhiambo walked into a health facility to deliver in 2020 and left with a healthy baby.

“I was also guided as I exclusively breastfed the baby for six months. Ringa women group has been supportive the entire period," says Ms Adhiambo.

According to the World Health Organization (WHO), every year, 1.3 million women and girls living with HIV become pregnant globally.

Without medical interventions, the rate of HIV transmission from mother to child during pregnancy, labour, delivery and breastfeeding increases. 

“Early identification of HIV infection with immediate linkage to lifelong treatment, viral suppression and support limits the rate of viral transmissions from mother to child,” says the global body.

In 2003, nine women living with HIV from Ringa, Rachuonyo East teamed up to create awareness on mother-to-child HIV transmission.

Ms Lucy Atella, one of the founding members who is HIV negative, says they train women on ARV adherence.

Ms Atella, a Community Health Promoter, says she holds health talks with the members during their weekly Tuesday meetings.

“We remind them that drugs should be taken as prescribed to achieve an undetectable viral load and reduce chances of transmission,” says Ms Atella.

The women also make follow-ups to ensure pregnant women living with HIV/Aids attend antenatal clinics once they conceive.

After delivery, the members continue to monitor the women to ensure they breastfeed exclusively for six months.

Ms Atella adds that new members are taken through a journey of acceptance, which has helped them speak about their status without fear of stigma.

Over the years, Ringa group membership has grown to 20, with four branches in Karachuonyo, comprising of 110 members.

To ensure the members are also economically stable, the group has a table banking programme, where the women can save and borrow.

According to Ms Atella, all the members have small-scale businesses to support their families. "In the past, we would hear cases of women defaulting on medication due to lack of food or due to financial instability. That is why we came up with the savings group," she says.

The efforts by Ringa group are among programmes helping lower mother-to-child HIV transmission in the county.

County officer in charge of Research, Innovation and New Learning Justus Ocholla said Rachuonyo East has been leading other interventions, with transmissions in Karachuonyo Sub-county currently below five per cent.

He adds that mother-to-child HIV transmission in Homa Bay County currently stand at 5.3 per cent down from 18 per cent in 2012.

"We are not yet below the 2.5 per cent target, but we hope to get there soon," says Mr Ocholla.

Some of the interventions by the county to lower the rate of transmission is testing all pregnant women for HIV during their first ANC clinic visit.

When one tests positive, they are immediately placed under medication and closely monitored by the health experts.

The expert says their efforts have also seen skilled deliveries increase from 48 per cent in 2012 to 78 per cent as of 2024.

He, however, notes that one of the challenges they still face is the women who default on their ARV medication once their health stabilises.

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