, MACHAKOS, Kenya, Nov 30 – When 28 year old Mwende (not her real name) discovered she was pregnant in 2004, she was devastated. This was not how she envisioned her future and so she toyed with the idea of aborting the baby.
But then, fear of death by abortion and morality took over and Mwende decided to keep the pregnancy. Before she figured out how she would break the news to her fairly traditional parents, rumors about her boyfriend\’s positive HIV status started doing the rounds.
"One of my friends would come and tell me that my boyfriend and future father of my child was sick. And then a neighbour would come and tell me the same thing. It was driving me crazy and as much as I tried to ignore the rumours, my pregnancy wouldn\’t allow me," she explains.
Mwende, who was at that time one month pregnant decided to continue hiding her pregnancy in an effort to buy time.
Meanwhile pressure at the government dispensary, where she had started her maternal clinics, continued to increase. Nurses advised her to get a HIV test and her brief escape from reality had come to a halt.
"My HIV results came back positive and the depression set in. I cried everyday for the following two weeks and would barely eat. How could I tell my parents about the baby and then follow up the shocking news with my HIV positive status? I just couldn\’t tell anyone," she recalls with a tinge of sadness in her voice.
Mwende blamed herself, her boyfriend and everyone else around her for her predicament.
"I couldn\’t stand my boyfriend and I hated him for infecting me with the virus. He had been my first lover and knowing that he knew about his HIV condition before we had any sexual relations but kept it secret from me made it worse for," she says.
She however adds that the doctors at the clinic gave her hope and helped her overcome her depression. Mwende figured she needed her family\’s support so she told them about her pregnancy but kept her HIV status secret.
"In fact the questions I had about keeping the baby or terminating it started coming up again because I didn\’t want to give birth to a sickly child. But then my doctor reassured me that my child would not get the virus if I followed his instructions," she says.
Her doctor started taking measures that would ensure HIV was not transmitted to Mwende\’s unborn child.
When she was eight months pregnant, Mwende was put on a combination of ARVs aimed at lowering her viral load as her due date approached. The cocktail of drugs is usually more effective in preventing HIV transmission from mother to child.
"I would take the drugs twice a day – in the morning and in the evening. About six weeks after I had started taking the drugs, I delivered a baby girl who was immediately given Nevirapine syrup before I was told not to breastfeed her," she explains.
If Mwende wanted to breastfeed then her daughter would have to take the drug (Nevirapine) for the entire period she was to be breastfed. This drug is used to prevent the transmission of HIV through breast milk.
After the birth of her child, Mwende started taking Septrin.
This drug is given to persons living with HIV to prevent common opportunistic infections such as diarrhoea, malaria or chest ailments. People with a CD4 count of less than 250 are normally placed on a combination of ARVs and Septrin while those with a higher CD4 count are only placed on the latter.
Her failure to breastfeed her child however started raising questions.
"People started talking. They would say that I have full blown AIDS to try and find an excuse why I was not breastfeeding. I kept giving false excuses even to my mother but no one was buying them. My main concern was my child. There were even women who said they would breastfeed my daughter for me," she explains.
However the truth eventually came out.
"I had hidden the drugs in my suitcase as usual and my mother happened to find them. She confronted me and I had to tell her the truth which was a relief because it had burdened me for a long while. It has not been easy but knowing she is there for me makes it better," she says.
Her daughter is now six and will be going to class two in January.
Anita\’s story is almost synonymous with Ms Mwende\’s.
However Anita who has been living with HIV for the past six years has four children. Her last three children were conceived and born when she was HIV positive.
"It was during my second pregnancy that I learnt of my HIV status but I kept it to myself. However after giving birth to my son, I decided to come clean and advised my husband to get tested. His results were also positive but I thank God that he didn\’t disown us," she says.
Anita adds that her doctors supported and guided her through all her three pregnancies. She says she did not breastfeed her second and third born children but decided to exclusively breastfeed her fourth born.
"The doctors advised me to stick to one regime such that if I chose to breastfeed a child, then I had to do it through out his/her entire infancy while at the same time giving him/her the Nevirapine syrup but I think not breastfeeding at all is a better option," she says.
She explains that keeping a child on the drugs is not easy.
"For example for my last born son, I had to know when to wean him off the breast milk while at the same time increasing his Septrin dosage. He would suffer side effects from time to time and I had to regularly take him to clinics for his HIV tests," she says.
She notes that although the other two children were also tested for HIV after they were born, it was not as periodic as it was with the last born.
"The doctors advised me to keep taking them for tests so as to be prepared because if HIV is caught early and the right measures are put in place, it will not progress to AIDS," she recalls.
Anita however notes that having to explain the reasons why she did not breastfeed her second and third born children was a taxing affair.
"People would call me all sorts of names because I wasn\’t breastfeeding. I would feel bad because much as I wanted to explain my situation, I couldn\’t. I remember my experiences with my mother-in-law were worst because she would put pressure on me to breastfeed but I still couldn\’t," she explains.
Machakos District Nutrition Officer Francis Mutinda says that it is important for HIV positive mothers to eat well balanced meals in order to maintain their strength and keep away opportunistic infections. He adds that the drugs cannot serve their purpose well if the body lacks the required nutrients.
"You cannot just take drugs without eating and as much as that might sound like common sense, people here don\’t eat very well perhaps due to poverty. But nevertheless we advise them to make good use of foods that are easily available in our district," he says.
Mr Mutinda further explains that patients who suffer from HIV are often advised to keep away from alcoholic and acidic foods.
"Most of the drugs given to persons with HIV react badly with alcohol because they normally have side effects such as nausea, headaches, vomiting which are normally worsened by alcohol. Besides alcohol often inhibits the usefulness of the drugs," he says.
He however notes that there is no special diet for persons living with the HIV virus.
Machakos District AIDS and STI Coordinator Nicholas Muindi says it is important for HIV positive persons to remain faithful to their treatment regimes.
"This prevents patients from developing drug resistance because when an individual with HIV stops responding to the drugs he or she is given, then we are forced to give them stronger medicines," he says.
He adds that eating well also helps manage the virus: "If you eat well and take your drugs as required then you are able to keep your CD4 Count levels above the minimum level. But if you don\’t eat well and your CD4 Count levels drop, then the doctors will be forced to put you on ARVs."
He also observes that because of the misconceptions of side effects that come up as a result of HIV medication, some patients refuse to accept reality.
"But you see this only makes it worse. And you know that the side effects people talk about can be managed. Sometimes we even change the treatment regime when the side effects are really bad. But acceptance is key," he says.
Although Mwende has not transmitted her HIV condition to any of her children, doctors continue to advise her to prevent any other pregnancies.
Dr Muindi explains that this is because pregnancy often depletes nutrients from the mothers to their unborn children.
"Pregnancies take a lot from mothers and you\’re more vulnerable as a woman if you have HIV. And besides that we still advise HIV positive couples to use condoms when engaging in sexual acts so as to prevent the transfer and exchange of the HIV strains," he explains.
Mwende also says that she does not want to get any other children: "I have to take care of the ones I have and I don\’t think my body has the strength to sustain another pregnancy."