Published in: MDG Centre | Columbia University
Last year, 103 HIV positive women gathered together in Sauri Millennium Village in Western Kenya to celebrate an extraordinary event – at 18 months, all but three of their children tested negative for the disease, thanks in a large part to a monitoring and retention scheme developed by the Sauri Millennium Villages Project health team. Sauri’s HIV Exposed Infant (HEI) Follow Up Program, as the scheme is called, was implemented thanks to an ongoing partnership between the Millennium Villages Project (MVP), UNAIDS, the Government of Kenya and other partners, focused on eliminating the transmission of HIV from mother to child. The graduation ceremony is one of several innovative grass-roots solutions developed by MVP health teams in ten African countries – Kenya, Uganda, Tanzania, Ethiopia, Malawi, Rwanda, Nigeria, Mali, Senegal and Ghana – to now show encouraging results, with instances of HIV infected infants now standing at less than 5%. In an effort to reduce this number further still, UNAIDS hosted a workshop for MVP health coordinators in Nairobi earlier this month, to share best practices and further hone solutions to creating HIV transmission-free zones by 2015.
Sauri’s infant graduation ceremonies are held four times a year, the culmination point of a follow up program for mothers and children which marks the transition point into a ‘safe zone’ where children are no longer likely develop HIV. Regular monitoring and treatment during pregnancy and up to the first 18 months of the child’s life are essential to prevent HIV positive mothers passing the illness onto their children. Frequently however, barriers such as stigma, lack of partner support, and long distances, prevent mothers in rural Africa from benefiting from regular care. The graduation ceremonies give mothers a powerful incentive to continue care, by rewarding those who attend regular clinics. They ensure that women remain within the continuum of care required to guarantee a fair chance of health for their babies. The event is part of a broader, four-step PMTCT strategy, which also involves the prevention of HIV in women overall, the prevention of unintended pregnancies among HIV-positive women, and care and support for HIV-infected women, their infants and their families.
The colorful ceremonies are a celebration for the entire community, who cheer and clap as mothers receive a certificate and commemorative gift. The event also serves as a platform for self-disclosure of HIV status, health education and for the recruitment of model mothers who act as mentors for newly diagnosed women. By disclosing HIV status in a positive way, the ceremonies are serving to reduce stigma surrounding the disease. In many African countries, stigma prevents people from undergoing testing and treatment for fear of being ostracized by the community. Sauri resident Rose Asiko can attest to this.
“Many women talked behind my back. They looked at me like I was already dead, and my children were frightened,” said Rose, upon receiving the news she and her husband were HIV positive. Despite the gossip, the couple held their heads high and attended the local clinic together for treatment. Rose joined a support group, and, since then, has been trained as a model mother, teaching newly diagnosed women about living with HIV and speaking out at the graduation ceremonies.
“Model mothers like me are helping to reduce stigma,” she says, “women used to shy away from support groups, they feared people would see them. Now they want to improve their lives by taking part in our activities. The women learn income generating activities like poultry farming, which give them confidence and hope. Both positive and negative-status women have joined us. The distinction is not important any more.”
Male involvement is also crucial to ensuring HIV transmission free zones. In large tracts of rural Africa, cultural barriers meant that men shied away from issues seen as the preserve of women, such as family planning and health. Two Millennium Villages stand out in devising effective strategies to attract men. In Mayange, Rwanda and Mbola, Tanzania, the project enlisted the support of the government to devise a “love letter” scheme, whereby women receive an official letter for their partners to accompany them to ante and post natal clinics and undergo HIV testing with their partners. The project has also coopted the support of community leaders, who have been trained on the importance of and now act as male champions to encourage health seeking behavior in their villages, as well as the importance of women. As a result, male testing for HIV in the ANC setting has also increased – in Mbola, 88.7% percent of men were tested for HIV in 2012, compared to only 54.2% in 2010.
On a broader level, UNAIDS and the MVP have been advocating at both national and global policy level, in an effort to ensure HIV transmission free zones by 2015. The partnership, established in 2009, is part of the broader call forwards the virtual elimination of mother-to-child transmission embraced by multilateral and bilateral agencies, regional coordinating bodies and national governments.
With less than 1000 days remaining before the deadline to achieve the Millennium Development Goals, lessons learnt from the Millennium Villages Project can serve as a model of how the spread of HIV can be prevented in poor, isolated communities in rural Africa using simple, inexpensive and community focused methods.