Sup­port­ive part­ners can curb HIV

Men can help to pre­vent new HIV in­fec­tions by show­ing up for their part­ners. Here’s how

Mail & Guardian - - Health - Joan van Dyk

Ntana Mh­longo, 31, looks down shyly as she de­scribes her part­ner Zakhele Sibiya. De­spite her ef­forts to hide her face, a smile lights up her fea­tures. “He loves the chil­dren. And he loves me,” she says, smooth­ing her black lace dress over her knees.

The pair have been to­gether for four years.

Mh­longo is seated in a near-empty room of her Buf­fel­spruit home in Mpumalanga. Out­side, her chil­dren are play­ing in a patch of golden af­ter­noon sun. The youngest of the bunch, four-month old Pearly, is sit­ting on her older sis­ter’s lap.

Pearly is Mh­longo and Sibiya’s first child to­gether. He is the only boyfriend she’s had who sup­ported her dur­ing and af­ter her preg­nancy. Ntana has four other chil­dren. “When the oth­ers found out I was preg­nant, they ran away.”

Pearly’s tiny hand grasps Mh­longo’s in­dex fin­ger as her mother ma­noeu­vres her lit­tle body to be­gin breast­feed­ing. Mh­longo is HIV pos­i­tive.

She looks down at her youngest daugh­ter. “Pearly is the only one I’ve been able to feed with breast milk ex­clu­sively,” she says.

For many HIV-pos­i­tive moth­ers, par­tic­u­larly those who are not on ef­fec­tive HIV treat­ment, feed­ing their ba­bies breast milk only for the first six months of their lives is about far more than just per­sonal choice.

When a mother is HIV-pos­i­tive, her breast milk will con­tain the virus and can be trans­mit­ted to her baby through the milk.

But stud­ies have shown that ex­clu­sively breast­feed­ing for the first six months of an in­fant’s life — giv­ing the baby noth­ing but breast milk, not even wa­ter — can help to re­duce the chances of a mother trans­mit­ting HIV to her child.

Re­searchers have found that mixed feed­ing can dam­age the thin lin­ing in their ba­bies’ in­testines, mak­ing it eas­ier for HIV to en­ter their blood­stream.

If the mother is on an­tiretro­vi­ral ther­apy (ART), though, the chances of her trans­mit­ting the virus through breast milk be­come al­most zero, stud­ies have shown — but only if she’s “vi­rally sup­pressed”.

In other words, only if she’s us­ing an­tiretro­vi­ral drugs cor­rectly and con­sis­tently — each day at the same time — and tests have shown that the drugs have re­duced the amount of HIV in her blood to such low lev­els that it has be­come sci­en­tif­i­cally im­pos­si­ble for her to trans­mit the virus.

Mh­longo tested HIV pos­i­tive in 2010 — one year be­fore the birth of her fourth child, Ja­cob. She started to use an­tiretro­vi­ral drugs soon af­ter­wards, and be­came vi­rally sup­pressed. Seven years later, by the time she gave birth to Pearly, she knew that, even if she did mixed feed­ing, the chances of her baby con­tract­ing the virus from her breast milk were al­most nonex­is­tent be­cause she was still vi­rally sup­pressed.

But, be­cause breast­feed­ing also has a mul­ti­tude of other ad­van­tages, she de­cided to breast­feed her baby ex­clu­sively.

Stud­ies have shown that breast­fed ba­bies are less sus­cep­ti­ble to dis­eases such as di­ar­rhoea and pneu­mo­nia. Breast­feed­ing can also pre­vent ba­bies from be­com­ing obese later in life and pro­tect against di­a­betes, a 2016 study pub­lished in The Lancet showed.

Breast­feed­ing a baby ex­clu­sively for six months, how­ever, has even more ad­van­tages.

Mixed feed­ing doesn’t only make it eas­ier for HIV to en­ter the blood­stream, it also opens up the way for in­fec­tions such as pneu­mo­nia, ex­plains head of the Health Sys­tems Re­search unit at the South African Med­i­cal Re­search Coun­cil Ameena Goga.

“Breast milk has ev­ery­thing that a baby needs in the right quan­ti­ties in an eas­ily ab­sorbable form.”

Be­tween 2001 and 2011, South Africa told HIV-pos­i­tive moth­ers to feed their ba­bies for­mula milk only in their first six months to avoid trans­mit­ting the virus, ac­cord­ing to the 2017 South African Health Re­view.

But this cre­ated a host of prob­lems. For­mula milk was ex­pen­sive and un­af­ford­able for many par­ents. And, although the gov­ern­ment pro­vided free for­mula milk for HIV­pos­i­tive moth­ers who breast­fed, clin­ics of­ten ran out of stock, or moth­ers couldn’t af­ford the travel costs to and from fa­cil­i­ties.

The re­sult? Many moth­ers gave mixed feeds or di­luted the for­mula milk. Some even mixed wa­ter with mealie meal.

Be­cause for­mula milk re­quires ster­ilised bot­tles and clean wa­ter, which many moth­ers didn’t have ac­cess to, ba­bies of­ten ended up with se­vere di­ar­rhoea and died of that rather than HIV.

But by 2012 the gov­ern­ment had phased out the for­mula op­tion in re­sponse to changes in World Health Or­gan­i­sa­tion (WHO) guide­lines for the feed­ing prac­tices of HIV-pos­i­tive moth­ers.

The pol­icy change came af­ter ev­i­dence emerged that women on ART dur­ing preg­nancy and breast­feed­ing had very lit­tle chance of trans­mit­ting the virus. The re­search was pub­lished in The Lancet In­fec­tious Dis­eases jour­nal in 2011.

The WHO’s ev­i­dence re­view also found that, com­pared to breast milk, for­mula was an in­fe­rior source of nu­tri­tion for ba­bies. In South Africa, the health depart­ment then stopped pro­vid­ing free pow­dered milk.

The health depart­ment’s cur­rent baby feed­ing pol­icy pre­scribes that all moth­ers should breast­feed their ba­bies ex­clu­sively for six months, re­gard­less of their HIV sta­tus.

But for most South African women ex­clu­sive breast­feed­ing is an im­mense chal­lenge — the coun­try has one of the low­est ex­clu­sive breast­feed­ing rates in the world. Only 7% of moth­ers man­age to feed their ba­bies breast milk only for six months, ac­cord­ing to the 2012 South African Na­tional Health and Nu­tri­tion Ex­am­i­na­tion Sur­vey.

In South Africa, the law also only pro­vides for four months of ma­ter­nity leave, tak­ing work­ing moth­ers away from their ba­bies, and mak­ing it im­pos­si­ble to breast­feed ex­clu­sively, un­less they’re able to ex­press milk and ap­point some­one to feed it to their in­fants.

When Pearly was two months old, Sibiya’s par­ents wanted Mh­longo to take her off breast milk and start to feed her pap.

But Sibiya fought for her rights: “No,” he ex­plained, “she needs to only get breast milk for six months. She will be much health­ier.”

Re­search shows that a sup­port­ive male part­ner in par­tic­u­lar could make or break whether moms breast­feed or not.

A 2016 pa­per pre­sented at the In­ter­na­tional Congress of Be­havioural Medicine Con­fer­ence in Mel­bourne showed that cul­tural be­liefs, such as con­cep­tions of what a man’s role should be in child-rear­ing, could neg­a­tively im­pact on the role men are will­ing to play in their part­ner’s preg­nancy.

The pre­sen­ta­tion was based on a small study of 53 men in Nkan­gala and Gert Sibande health dis­tricts in Mpumalanga.

Many men feared that, if they as­sisted in the house­work or care of the baby, peo­ple would think their wives had given them a love po­tion.

Some be­lieved they were only ob­li­gated to pro­vide fi­nan­cial sup­port or ar­gued that cul­tural be­liefs dic­tated that they should keep their dis­tance once the baby is born.

Some said clin­ics only catered for, and were dom­i­nated by, women.

A 2018 African Jour­nal of Nurs­ing and Mid­wifery study rec­om­mends that health fa­cil­i­ties cre­ate con­di­tions that would pro­mote fa­thers’ or male part­ners’ will­ing­ness to par­tic­i­pate in feed­ing.

But Sibu­siso Si­funda, the chief re­search spe­cial­ist at the Hu­man Sciences Re­search Coun­cil’s HIV Unit, says there is still very lit­tle ac­knowl­edge­ment of the role fa­thers can play in sup­port­ing ex­clu­sive breast­feed­ing and, in the process, pre­vent HIV trans­mis­sion.

To­day, fewer than 3% of ba­bies born to HIV-pos­i­tive moth­ers in South Africa con­tract the virus thanks to ARV treat­ment, ac­cord­ing to a 2013 Med­i­cal Re­search Coun­cil eval­u­a­tion car­ried out among ba­bies two months or younger. But by the time ba­bies reach 18 months, this pro­por­tion jumps to about 4% shows data pre­sented at the 2016 In­ter­na­tional Aids Con­fer­ence. Breast milk from moth­ers not vi­rally sup­pressed likely plays a ma­jor role in these new in­fec­tions.

That’s why South Africa’s new plan aims to im­prove ser­vices to di­ag­nose preg­nant women with HIV and im­prove their ad­her­ence to ARVs.

But bar­ring broad com­mu­nity pro­grammes, the Mpumalanga health depart­ment could not name any in­ter­nal ma­ter­nal health pro­grammes that in­volve men.

Get­ting men in­volved isn’t the prov­ince’s only prob­lem.

Only 34% of peo­ple on HIV treat­ment in the prov­ince are vi­rally sup­pressed — it’s one of the low­est rates in the coun­try, ac­cord­ing to a 2017 pa­per pub­lished in the South­ern African Jour­nal of HIV Medicine.

In ad­di­tion, a study pub­lished in the In­ter­na­tional Jour­nal of En­vi­ron­men­tal Re­search and Pub­lic Health in 2017 found that about a quar­ter of a sam­ple of 700 HIV­pos­i­tive women were tak­ing their ARVs in­cor­rectly.

Those who were preg­nant, or who did not breast­feed ex­clu­sively, in­creased their ba­bies’ risk of con­tract­ing HIV.

But as Mh­longo ex­pe­ri­enced be­fore she had Sibiya in her life, there are end­less stum­bling blocks to ex­clu­sively breast­feed a baby with­out the sup­port of the father.

When she was preg­nant with her fourth child, Ja­cob, she had to leave her baby with her mother, be­cause she did odd jobs to sup­port her fam­ily.

Even when she ex­pressed breast milk to leave with her ba­bies, fam­ily mem­bers left in charge of the young chil­dren of­ten sub­sti­tuted the ba­bies’ di­ets with other foods such as mealie meal.

Goga says that the 2011 change in gov­ern­ment pol­icy has left some myths about breast­feed­ing. “Peo­ple still want to say you should ex­clu­sively breast­feed or not at all. In ac­tual fact, as long as you’re vi­rally sup­pressed some breast milk is bet­ter than none.”

This ap­proach to mixed feed­ing is men­tioned in the WHO’s guide­lines, but to avoid con­fu­sion the health depart­ment has not in­cluded it in lo­cal plans, Goga says.

But back in Buf­fel­spruit, Mh­longo is de­ter­mined to breast­feed her daugh­ter ex­clu­sively. All her chil­dren are HIV neg­a­tive. “I’m happy I can be home to breast­feed Pearly,” she says.

“I know if I left her here with the fam­ily, she might be fed with other things.”

Many men feared that, if they as­sisted in the house­work or care of the baby, peo­ple would think their wives had given them a love po­tion

Love and other drugs: Men play a cru­cial role in keep­ing ba­bies HIV neg­a­tive. Photo: Dy­lan Bush

Newspapers in English

Newspapers from South Africa

© PressReader. All rights reserved.