Eight years ago, when Alzira was 15, she found out that she was HIV positive. If she had been diagnosed today, she would have started antiretroviral therapy (ART) right away, in accordance with WHO “Treat All” guidelines and national policy in Mozambique. But eight years ago, the standard was different. Because Alzira was in good health, clinicians at her local health center told her she had to wait before beginning treatment.
Two years later, Alzira became pregnant with her first child. ART is a key part of preventing mother-to-child transmission (PMTCT) of HIV, so Alzira started treatment in order to ensure that her child would be born free of HIV infection. Unfortunately, the nearest health facility where she could receive ART medication was a 30-minute walk away, a long distance to walk while pregnant. And because of the stigma in her community against HIV, she did not want to be seen going to the clinic. With no one to talk to or reach out to for support, she struggled to adhere to treatment.
Even though Alzira may have felt alone, she is not. An estimated 1.8 million people in Mozambique are living with HIV, including nearly a million women and children. One in five pregnant women living with HIV in Nampula Province transmit HIV to their babies, but ICAP and its local partners are working to change this. Starting HIV-positive mothers on ART as soon as possible, going the extra mile to retain them in care, and providing counseling to help them stay on treatment are all part of a successful PMTCT strategy that can keep mothers healthy and give their babies the best chance at starting life without HIV infection.
In Nampula Province, ICAP supports maternal and child health through programs that provide HIV prevention, care, and treatment, including PMTCT and early infant diagnosis (EID). One innovative strategy, which is part of ICAP’s effort in Mozambique to accelerate progress toward the UNAIDS 90-90-90 targets, is employing Mentor Mothers to provide individualized support to pregnant and breastfeeding women living with HIV. These activities are supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC).
In the Mentor Mother program, experienced mothers who are living with HIV are supported by ICAP to conduct home visits to pregnant women who are on ART, to seek out women who are reported “lost to follow-up” and re-link them to care, and to facilitate mother support groups and health talks. These Mentor Mothers are based in the community and at high-volume health facilities (defined as seeing more than five HIV-positive pregnant women per month) around Nampula. An important aspect of this program is that all pregnant women newly diagnosed with HIV at ICAP facilities are accompanied to their homes by a Mentor Mother on the same day of diagnosis. This gives Mentor Mothers an opportunity to offer one-on-one counseling and to share their experiences living with HIV.
“The Mentor Mother program has dramatically improved retention in care and reduced loss to follow-up for pregnant women and their babies,” said Mirriah Vitale, country director for ICAP in Mozambique. “In addition to peer support, Mentor Mothers also educate the mothers in their care about the tests and services they should be receiving, and we are seeing increased demand in several key areas. For example, 80 percent of women in sites with Mentor Mothers are receiving viral load testing during pregnancy, versus 51 percent in sites without. This is extremely encouraging as we are working towards an AIDS-free generation.”
During her first pregnancy, Alzira connected with Catarina, a Mentor Mother who visited Alzira as often as three times each month to provide counseling about continuing ART. Catarina had been a health activist in her community. After receiving additional training through ICAP to become a Mentor Mother, she was motivated to help young women like Alzira.
Now, as a mother of three (9 months, 3 years, and 6 years), Alzira looks back on her pregnancies with gratitude and relief. By remaining on ART and adhering well to treatment, she protected all three of her children from HIV transmission through pregnancy and breastfeeding. During her last pregnancy, with Catarina’s encouragement, Alzira received viral load testing, and just a few weeks later celebrated the news that she had reached viral suppression, meaning that, as long as she continues to adhere to treatment, her HIV is untransmittable.
“Catarina is an excellent listener,” Alzira said. “She’s the only person I could confide in about my HIV status.”
This International Women’s Day, March 8, ICAP honors all of the women who are working to create a healthier future—for themselves, their children, their peers, and their communities. Through courage and strong relationships, women living with HIV and their allies are breaking down barriers of stigma and discrimination in order to lift one another up and ensure equal access to health for all.
A global health leader since 2003, ICAP was founded at Columbia University with one overarching goal: to improve the health of families and communities. Together with its partners—ministries of health, large multilaterals, health care providers, and patients—ICAP strives for a world where health is available to all. To date, ICAP has addressed major public health challenges and the needs of local health systems through 6,000 sites across 30 countries. For more information about ICAP, visit: icap.columbia.edu
Header photo: Catarina (left) and Alzira outside the Nampula health facility. Photos 2-3: Mentor Mothers at the Nicoadala health facility in Zambezia Province, Mozambique. Photo 6: Alzira outside the Nampula health facility.