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SWAZILAND: Pregnant women still struggle to prevent HIV
17 Jul 2008 17:21:37 GMT
 Source: IRIN

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MBABANE, 17 July 2008 (IRIN) - Larger numbers of pregnant women living with HIV in Swaziland can now access services to prevent mother-to-child transmission of the virus, but activists and health officials say more emphasis should have been placed on quality rather than quantity.

"The programmes are going well, but we have a lot to do to ensure quality of services - it is more than a matter of blocking transmission. The health of the mother, of the family, has to be linked to the care services available," Dr Mohammed Mahdi, deputy director of the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) in Swaziland, told IRIN/PlusNews.

Swaziland's Ministry of Health and Social Welfare and EGPAF have been partners since 2003 in rolling out the prevention of mother-to-child transmission (PMTCT) programme. "In Swaziland there are 154 sites providing PMTCT services; that is coverage of 71 percent, and this is quite encouraging. Government is intending 100 percent coverage by 2011," said Dr Mahdi.

Overcoming gender barriers

But deep-rooted prejudices toward people living with HIV and AIDS, and the customary second-class role of women in society, which persists despite new constitutional guarantees of gender equality, are proving troublesome. A mother often has to face the possibility of rejection by her family if she wishes to ensure her health and the welfare of her baby.

"Swazis are hard on a woman who is HIV positive ... A woman has to choose between secrecy, and the health of her baby and her own health," said Siphiwe Hlope, founder of Swazis for Positive Living (SWAPOL), an AIDS support organisation that was originally only for women.

According to Hlope, women often found it difficult to keep their HIV-positive status a secret. "Because of Swazi culture, it is not possible for her to hide her condition from her family. A man can take ARVs in secret; a woman is more exposed - it is because of the breastfeeding issue."

In a communal, multi-generational Swazi household, a baby is often breastfed by more than one woman for up to two years. But in the age of HIV/AIDS, this practice is dangerous.

Government guidelines recommend that the mother exclusively breastfeed for six months; if possible, she should then provide formula-feeding.

"Depending on affordability and safety conditions, they can use formula, otherwise mothers are counselled to continue with breastfeeding but complement this with culturally acceptable nutritious local foods for the baby," said Dr Mahdi.

To spread this message, health motivators counsel HIV-positive women during pregnancy. "If you stop breastfeeding earlier than six months and begin formula-feeding, the tendency we found is that the woman will mix breastfeeding with formula-feeding, which is dangerous in terms of transmission," Dr Mahdi warned.

Exclusive breastfeeding for the first six months is also a UNICEF recommendation, as mixed feeding can damage the baby's fragile gut lining, increasing the risk of infection. "The best available option for resource-constrained countries like Swaziland is exclusive breastfeeding for six months," said Dr Mahdi.

Advertising by breastfeeding

But following such a regimen also tells the woman's family that she is HIV positive. "At home, they would want to know why she is not allowing other women in the family to breastfeed her baby," Hlope explained. "Secondly, she has to wean the baby after six months, and Swazis do not understand why the baby should not be breastfed for two years."

Once a woman has been forced to disclose her status there is also the risk of partner violence. "The husband and the family say, 'Oh, you are HIV positive, you brought this disease into our house'. There is still a stigma, and you can't run away from that," said Hlope, whose husband left her after infecting her with HIV, but blamed her.

"I would say Swazis are cruel to women who are HIV positive. They think a man cannot transmit HIV to a woman; that women are carriers of HIV/AIDS," she said.

Hlope's organisation, SWAPOL, has taken legal action on behalf of HIV-positive women whose homes and possessions have been confiscated by their husband's relatives in retaliation for "bringing death to the family", leaving the widows and children destitute.

Two-thirds of Swazis live in chronic poverty, according to the UN Development Programme, and many depend on the traditional social safety net provided by a supportive family for their survival.

Losing that safety by disclosing her HIV status is a dreadful prospect for a Swazi mother with nowhere else to turn. And yet, many Swazi women are choosing the health and safety of their child over possible ostracism and financial ruin.

The nation's traditional social fabric is under pressure. Fifteen years ago, before the HIV prevalence rate in Swaziland grew to being amongst the world's highest, infant mortality stood at below 100 per 100,000 live births; now, 120 out of 100,000 newborns die, despite the resources devoted to the AIDS battle.

jh/kn/he

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