JOICE Moyo*(36) quivers whenever she recalls an ordeal she encountered while giving birth to her second child seven years ago.
A mother of three, Moyo has been living with HIV for more than 15 years. Her dream was to give birth to virus-free children as she was certain that with the correct use of the available mother-to-child transmission interventions, she was likely going to achieve this goal.
Today whenever she looks at her second born child, her heart breaks as the child is growing up living with HIV.
She has a lifetime scar.
She gave birth at a clinic in Harare, but nurses that assisted her delivery failed to administer Nevirapine to the child.
Nevirapine is an antiretroviral medication which typically prevents the mother-to-child transmission (MTCT) of HIV.
Just like any other mother living with HIV, Moyo had always been thoughtful and cautious with her medication as she was optimistic that all her children would be born negative.
“What pains me the most is that throughout my pregnancy, I was taking my medicine as recommended so that my child would be born HIV negative, but now my son is positive, most probably due to a mistake that was made during birth,” said Moyo with tears rolling down her eyes.
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This is the fourth part of the series, The high cost of motherhood: A silent maternal epidemic in Zimbabwe, supported by the International Women’s Media Foundation’ Howard G Buffet for Women Journalists.
Globally an estimated 1,3 million women and girls living with HIV become pregnant each year and in the absence of intervention, the rate of transmission of HIV from mother to child during pregnancy, labour, delivery or breastfeeding ranges from 15 to 45%, according to the World Health Organisation (WHO).
In 2019, about 85% of women and girls globally had access to antiretroviral therapy (ART) to prevent MTCT.
Moyo adds to the statistics, but the irresponsibility of nurses has cost her son as they failed to recognise the mother’s HIV status as recorded in the antenatal care book since she collapsed soon after delivery.
“I gave birth at around 2am in the morning. Soon after giving birth, I fainted due to severe bleeding and woke up later at around 8am lying in a hospital bed. The nurses on duty brought me the baby and with joy I started breastfeeding my baby and forgot to ask if he had been given his first dose of Nevirapine which up until this day I regret not having done a follow up and asked,” Moyo said.
However, WHO emphasised that high ART coverage levels do not reflect the continued transmission that occurs after women are initially counted as receiving treatment seeing the need to have an integration of interventions that led to the Triple Elimination Initiative, which cannot only promote person-centred care, but also reduces incidence, morbidity and mortality.
When Moyo was discharged, she took her son home along with some medicine for the child.
At home, she continued with the medicine for both her and the baby but in about 10 months’ time, her baby started having open sores on his scalp, thrush in the mouth and ear problems.
Moyo took the boy to a local clinic for treatment and he was tested for HIV unfortunately she could not get a proper diagnosis since he was said to be on a window period.
The worst nightmare struck when the child turned one year and six months old. The little boy tested HIV positive.
“I was shattered considering the efforts that I had to make to ensure my child is born negative,” Moyo told the NewsDay.
Zimbabwe Municipalities Nurses and Allied Workers Union president, James Tafirenyika, blamed the nurses for Moyo’s agony stressing that nurses should check patients’ log books for health status.
“In this case, I would blame the nurses who attended the lady, they were supposed to do due diligence on the patient and follow all procedures and give the child Nevirapine on time because in Zimbabwe we have what we call antenatal care,” Tafirenyika said.
According to him, the case was supposed to be reported in time, but now the challenge could be tracing down on who attended Moyo, considering the current health situations where a midwife, nurse, student or nurse aide could have attended her.
Recent findings by the Training Programmes in Epidemiology and Public Health Interventions Network (TEPHINET) a global network of field epidemiology training programmes strengthening public health systems worldwide revealed that over the years, Zimbabwe has been making significant progress towards elimination of MTCT, but in 2020 the country experienced an increase in MTCT with Harare province recording the highest number among all the 10 provinces.
According to TEPHINET’s findings, the increase in MTCT was associated with late maternal HIV diagnosis and non-adherence to ART and interruptions to paediatric ART.
This shows that despite high ART treatment coverage among pregnant women for prevention of MTCT of HIV in Zimbabwe, the MTCT rate is still high.
In 2016, the country adopted WHO recommendations of stratifying pregnant women into “High” or “Low” MTCT risk for subsequent provision of HIV exposed infant with appropriate follow up care according to risk status.
SALT AFRICA co-ordinator and counselling psychologist Tafadzwa Meki said the case of Moyo and how her child ended up testing HIV positive was a complicated one which required to be handled well.
“Mom guilt is a real phenomenon regardless of your HIV status. I can only imagine what she is going through as a mother knowing that this was her responsibility but at the same time she could not do anything not because she didn’t want to but because she was unwell,” Meki said.
“I feel that there was a little bit of a lapse on the side of the medical team because one should have done due diligence, someone should have asked this woman for her HIV status which is part of the procedure for every expecting mother. Unfortunately, this has happened and now she needs to seek therapy so that she can forgive herself,” said Meki.
However, Tafirenyika urged mothers to plan well and register their pregnancies early to prevent late uptake of necessary treatment like ART.
