UNITE FOR CHILDREN UNITE AGAINST AIDS

September 1, 2008

The woes of an HIV positive breastfeeding mother

A few weeks ago, I visited the Silele Red Cross Clinic in Swaziland’s Shiselweni region after I met one of the nurses who had gone for TB training to enhance tuberculosis treatment at the clinic. The clinic had not been treating this infectious disease since there was no nurse trained on administering TB drugs and yet with the spread of HIV, there is a tuberculosis outbreak in the country. 

The nurse told me about the case of a very sick HIV-positive woman, Siphiwe, who had tuberculosis. She described how her social background was contributing to her multiple problems which were worsening her health condition. The nurse was worried because it was beyond what she or the clinic could do to help.

Siphiwe N. is a 28 year-old Swazi woman, a mother of four children including 5 month old Melusi who is breast-feeding. Siphiwe’s husband, Bhekithemba, is not working and will not take up a temporary job. Siphiwe stays at her in-laws place where she does not see eye to eye with her mother-in-law due to her HIV status. She believes Siphiwe is to blame for contracting HIV.

Together with the nurse, we made a home visit to Siphiwe. We found her at a Neighbourhood Care Point, built with UNICEF support, where she had gone to get a meal for the day with her children. Neighbourhood Care Points provide children with one meal a day and informal education as well as an opportunity to play. This is how Siphiwe relates her story:

“I tested during pregnancy and was found HIV-positive. The nurses say I now have a CD4 count of 71 which means my immune system has weakened to a very low point and that I should have long started taking antiretrovirals (ARVs). The nearest Clinic which is Silele does not offer ARVs and I have no money to travel to the Hlathikhulu Hospital where they can offer them to me.

“The situation is made worse because my husband does not support me. He refuses to be tested for HIV. My mother-in-law gives food to my husband but she tells me to go back to my parental home as I am a disgrace to her family. My husband does not even share the food with our children and that is why I am grateful to the Neighbourhood Care Point because we are able to get one meal a day. At times I am assisted by a Rural Health Motivator, Mrs. Mathabela, who gives me some food when she has,” explains Siphiwe.

I came back to the office and spoke to UNICEF’s Dr Fabian Mwanyumba who recommended that she be referred to the Hlathikhulu Hospital where they will determine if she can start Anti Retroviral Therapy (ART). We then organized some transport money for her to go to Hlathikhulu where the doctor recommended that she starts using ARVs immediately.

Currently, Siphiwe is taking the TB treatment as well as ARVs. However, I have my own fears on whether she will not have a problem of drug compliance as she has no support from the family. Furthermore, supplies are taken from far and she needs regular food intake in order to take her medication. I have requested the community leadership to speak to her husband and mother-in-law about Siphiwe’s situation. I will also follow-up to find out how she is coping after starting her ARVs.

Unfortunately, Siphiwe’s situation is not uncommon and there are many Swazi women who experience similar problems at the hands of their spouses and in-laws. To help counteract this, UNICEF has an ongoing community mobilization programme that targets men to support their wives on the Prevention of Mother to Child Transmission of HIV. This program also emphasizes the positive role of husbands in caring for their HIV-positive wives and babies. But the programme needs strengthening with more financial resources in order to reach many communities and help change men’s attitudes on caring for women, especially their wives and children.