Preventing mother to child transmission
About a month ago, I shadowed Jacob in the outpatient department where he was doing HIV testing and counseling with individuals and couples. The very first session I saw involved a couple who had been referred for testing after the wife had fallen sick. After completing the pre-test counseling, the HIV rapid tests were ready for reading. They were presented to the patients in a way so that they had ownership over their results. The husband saw that he was positive, and 30 seconds later, his wife was given the same results. The man looked stunned, and the woman put her head in her hands. A long silence ensued until the man slowly made eye contact with us and asked, “So what do we do now?” We answered his questions, attempted to put them at ease, and listened. We told him about meds and a referral to the HIV clinic, while his wife continued to stare off at the ground.
In one morning, we did 49 rapid tests and counseling
HIV testing is still something that is met with apprehension, not just in Uganda, but in all settings. I’ve talked to a number of health professionals in the hospital who themselves are afraid of going in for testing. After that first experience with Jacob, it’s become much clearer why that fear exists. The threat is so real. It makes sense logically that people should just get tested so that they find out their status and then get treated accordingly if necessary. But when you put it in the social structure and cultural context of HIV testing in Uganda, the underlying reasons for the fear no longer seem unwarranted … the stigma from the community… the different gender expectations…the potential of families falling apart… marriages breaking up.
I worked in the hospital’s PMTCT (Prevention of Mother to Child Transmission) clinic for a good chunk of time this past month with pregnant mothers and occasionally, their spouses who had accompanied them. The goal at PMTCT is to find out the status of the mothers, and regardless of the mothers’ status, ensure that the baby is negative. I did both finger prick rapid tests and one-on-one/group pre-test counseling where we talked about HIV transmission, specifically mother-to-child. We talked about risk-taking behaviors, prevention, and treatment options for positive mothers. We always emphasized the importance of sharing that one has been tested and to encourage brothers, sisters, and friends to come and get tested. After all, it is free, as is treatment.
PMTCT counseling sessions
Women often express concern about their husband’s whereabouts, especially those that work far away from home. Many have also felt powerless in negotiating the use of condoms. As a result, Mengo has “Men’s Access Day” every last Friday of the month where men can come in and have specific testing, counseling, and education alongside dozens of other men. When the patients say that they are ready to see the results, the atmosphere usually changes. Sometimes they become nervous, sometimes they hold my hand, sometimes they anxiously laugh, sometimes they’ll turn stone-faced. Most of the clients are negative, and I can see the relief wash over them. However, it’s difficult to gauge what the results mean to them. Was this a wakeup call, or was this a free ticket to more risk-taking behavior?
Testing and sorting rapid tests
The issues that arise stem from the fact that HIV is not what it was ten years ago. In Africa, where the ARVs were either unavailable or wildly expensive, being HIV+ was essentially a death sentence. Now with the Global Fund, PEPFAR, and other donors stepping in to provide essential medications, HIV is just another chronic, manageable disease like diabetes. A recent study showed that those with HIV who are taking ARVs have the same life expectancy as the average HIV negative Ugandan. I’ve heard from so many people that Ugandans are far less scared of HIV than they were a decade ago. On the one hand, this means that people are more willing to get tested and treated compared to the past, although it’s a slow growth curve. On the other hand, it means that people are becoming less concerned about engaging in HIV risk-taking behaviors. In the 1980s, the HIV rate in Uganda was near 25% In the 90s, it dropped to 15%, and it recently came to an all time low around 6%. However, that rate is spiking up again for the first time in decades. This dynamic of being fearless and fearful when it comes to HIV testing has continued to have an effect on health-seeking behavior and thus the HIV positivity and treatment rates.
