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Wednesday, November 24, 2010

Child bearing in the era of HIV and AIDS- Dedication to Elizabeth Glaser on what would have been her 63rd Birthday!

..the case of managing pediatric Aids
A woman without a child in the majority of our communities is not a complete woman. A recent study by the National Association of People Living with HIV and Aids (NAPHAM) indicates that stigma against infertile women has forced many of them to take drastic measures to avoid ridicule.
From committing suicide to prostitution, women without natural bearing capacity seem not to find solution in society already known for its conservative view of unmarried older persons. This is however an ignored area and many suffer or die in silence.
The agony experienced by such women might seem to be lesser if one considers those that loose their children during delivery. After carrying a baby in the womb for nine whole months, the pain would be greater only to hear muted sounds of disbelief due to the early death of the newly born child.
The realities are difficult to comprehend for males and many who have yet to experience the loss of their own child. However for many mothers or would-be mothers the life long scars of such death will never be erased.
As Malawian women are grappling with staying alive during and after delivery and keeping the child alive, the emergence of HIV and Aids has also added to the misery, as children born with Aids are expected to die within the first fifteen years of their lives.
This is the worst form of physiological torture, as a woman who tests HIV positive during pregnancy has to carry the same, unknowing the fate of her coming baby. The worst part is when has to stay with an HIV positive baby hoping for the impossible, that cure or simply a miracle would happen.
In the Absence of Angels, an autobiography of Elizabeth Glaser founder of the Elizabeth Glaser Pediatric Aids Foundation, she sums up the fears after she infected two of her children Ari and Jake, after a blood transfusion during delivery of Ari.
Glasers account of fear of discovery and even rejection of her family and children by neighbours and friends. Some of the so called friends even stopped the children from visiting their home.
She talks of her period she cried and cursed God as she watched her daughter loosing her life to the deadly virus, the long wait of AZT which was not readily available for children in its early stages and scaring moments when she thought she could just gas her whole family.
Elizabeth, after the death of Ari in August 1988 only came out to disclose her family status in 1989, she along side her two friends Susie Zeegan and Susan Delaurentis to start a foundation that would raise money for pediatric HIV and Aids research.
Locally there are hundreds of women who now dread child bearing due to fear of having HIV positive, killing the hope and joy of many lives that would have come out of their wish to have a child.
Combining the three-infertility, high child mortality rates and now HIV infection, one would look at child bearing as a high risk business that would bring more sorrow without a solution but at the same time the stigma of having no child could force many to take the risks of attempting to have a child.
Compounding the problem of child bearing includes the superstition, early marriages or child bearing which in other cases has resulted in fistula or eventual deaths and also some cultures which see most of single women being forced into relationships as part of communal security.
Amidst such a dark background, hope though is slowly returning to many families, as institutions have evolved to recognize pediatric Aids management as one of crucial areas in curbing child mortality.
A woman in her late 20’s tested HIV positive in 2008 during the National HIV testing week and hid her infection from her husband. Months later she became pregnant which created fear and restlessness in her daily life.
“I could not think of anything for long except that I was dying and alongside that my baby. Until I went to Bwaila Hospital in Lilongwe, I started antenatal care and HIV treatment. Today I have a one and half year child who is HIV negative,” explains a woman whose anonymity is due to the fact that she has yet to tell some of her family members.
She is among the 290 000 women Elizabeth Glaser Pediatric Foundation supported Prevention of Mother to Child Transmission (PMTCT) programme has reached. By December 2009 38,000 women and infants have been provided with lifesaving antiretroviral drugs to prevent transmission.
The bold decision almost twenty years ago by Elizabeth Glaser after the death of Ari in August 1988 to come out and disclose of her status and start a foundation with the support of two friends, today has created hope, brought back smiles and HIV infections among the newly borns seem manageable.
The Foundation is the leader in global efforts to eliminate pediatric AIDS, working in 17 countries at more than 4,800 sites. It is the world largest provider of “10 years ago people didn’t think we could bring PMTCT services to developing world; 5 years ago we were only reaching 15% of women who needed PMTCT; today we are reaching 45%: a major accomplishment but need to reach more women, faster,” reads part of Foundations publications.
In Malawi alone close to one million people are said to be living with HIV and Aids and more than half around 490,000 are women while almost 100,000 are children below the age of 15, making the management of pediatric Aids as part of crucial national control programme.
20,000 children are said to be infected every year with HIV.
Apart from helping to reduce infections, preventing mother to child transmission reduced future expenses rising from the demand for more life-long therapy by the HIV positive that are growing up with the virus.
The development of cost effective measures that are available to prevent such transmission need to be made accessible to pregnant women currently estimated to reach only half of those that are in need of such measures.
Managing pediatric Aids, will give room towards eventual reduction of maternal and child mortality, reduce infections and management costs of Aids and also bring back a smile, create hope and bring laughter back into our communities.
Institutions coming in the field such as Callitsa Mutharika Safe Motherhood Foundation could do well to support creation of access to PMTCT by all pregnant mothers which would be the single most important achieving elimination of pediatric Aids.
As Elizabeth Glaser sums it all, there are many angels out there, by reaching out to those that are facing such life crisis in an era of medical advancement and probability of eradicating mother to child transmission.
It is possible to have a smiling mother in all Malawian villages and make child bearing an occasion to look forward to-HIV positive or not.
Ends.

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