The most common way for children to get infected by HIV/AIDS virus from their mothers is called Vertical Transmission (VT), which occurs during pregnancy, delivery and/or during breastfeeding. In order to prevent or reduce the risk of this transmission from mother to child, it is necessary that pregnant women go for prenatal consultation from the beginning of the pregnancy or after the discovery of the pregnancy. In cases of infection, it is necessary to take appropriate treatment with the health professional, following up on prenatal consultations for appropriate monitoring and carrying out the requested examinations.
Perpétua Agostinho, as a health activist at the Acoepaza Association, in Quelimane city, central province of Zambezia, has been working with HIV-positive people and key population. In an interview with the Citizen Observatory for Health (OCS), the activist revealed that the non-compliance of prenatal consultations is one of the main concerns that her association has been facing on a daily basis, with such attitude even contributing, in some way, to the transmission of the virus from mother to baby.
“In some communities in Zambezia province, pregnant women do not attend prenatal consultations, which somehow contributes to the occurrence of mother-to-child transmission of the virus, because up until the moment of delivery, the health status of these women is unknown, and others discover at that very moment that they are HIV-positive”, she said.
Besides women who find out that they are HIV-positive at the time of delivery, according to Perpétua, there are also HIV-positive people who refuse to follow treatment.
According to the Annual Report on HIV/AIDS Related Activities for 2021, made public by the Ministry of Health, the early retention rate in Pregnant Women on Antiretroviral Treatment (ART) was between 85% and 92% in the first month after starting ART and at the third month between 88% and 93%, with the average retention rates being 89% for one-month early retention and 90% for 3 months.
According to the same report, to ensure that prevention of Mother-to-Child Transmission is effective, concerted actions are needed including timely arrival at the first antenatal visit, associated with provision of the full package of care for HIV and Syphilis in a timely and continuous manner. Other actions include promotion of institutional delivery, partner engagement and interventions to improve treatment adherence and retention to treatment.
Currently, also according to data from the same report, the country has a high coverage of the first prenatal consultation (123%). However, there are still constraints in the retention of pregnant women in prenatal consultation, with only 63% of pregnant women having had 4 or more prenatal consultations.
Likewise, institutional deliveries remain a challenge at the national level, with 89% coverage.
As a way of reducing the risk of vertical transmission of HIV, the report points out that interventions are still underway to expand universal access to ART for pregnant and HIV-positive women, and efforts have been mobilized so that all health facilities, corresponding to 95% of the national network, provide ART for vertical transmission.
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According to Perpétua Agostinho, despite the concern for the Vertical Transmission, there are positive aspects that the activism is registering, such as, for example, the sensitization of people who had already abandoned the treatment.
“In Nicoadala, for example, in the village of 3 Tyres, I came across situations of people infected by the HIV-AIDS virus and who wanted to give up the treatment for nothing. But I managed to sensitize them”, she said.
One of the most serious cases that the activist has observed has to do with a young girl who was very ill but neglecting to take Anti-Retroviral treatment.
“I asked her mother if she had been to hospital and she said yes, but she wasn’t getting better, that’s why they opted for traditional treatment. I pressured her to tell the truth, that’s when she confessed that her daughter had been tested for HIV and was positive, but she didn’t want to take the Anti-Retroviral treatment”, she explained.
Perpétua ended up convincing the patient to go to the hospital, before it was too late. However, despite the fact that the patient took the treatment in the first days, she once again gave up the drugs, lying them down or hiding them.
It took another sensitization session before she understood that the best way to save herself lay in antiretrovirals.
“When she finally started following the treatment, she made significant improvements and to this day she is doing well. The secret of HIV/AIDS is to stick to treatment”, she said.
About the challenges that she faces daily as an activist, the source criticized the slowness of care for patients who enter hospitals, stressing that many times, due to negligence on the part of the staff, they take a long time in the waiting line.
Perpetua also denounced corruption and the prioritization of certain patients to the detriment of others.
“I don’t know if there is a rule or law for them to prioritize certain individuals to the detriment of others”, she said, stressing that “this is one of my concerns. Several times we have seen situations of poor service, slowness and prioritization of white individuals to the detriment of black ones”, he stressed.
“Another major problem that we face, in the health units, has to do with the lack of medicines. Even paracetamol, sometimes, is scarce in hospitals”, she concluded.