"My name is Chikondi Chikaonda. I am living with HIV and started child bearing at the age of 15. My first husband died on 29 August 2009, when I was pregnant."
Chikondi left secondary school at the age of 13. "I attended my first antenatal clinic in 2009 while six months pregnant. Now I have three children, all HIV negative, born at this Chileka Health Centre," she says.
Chikondi comes from Dzuluwanda village, Traditional Authority Kalolo in Lilongwe. She has three children - Trifina Kapakasa (ten), Sikola Kapakasa (seven) and Catherine Chizumba (two years and ten months). Trifina and Sikola are being raised by their grandmother in the rural Ntchisi district in central Malawi, where they attend school, while Catherine is raised by her mother as a single parent.
Catherine in Option B+
In Malawi, HIV prevalence is high among pregnant women (10.6 per cent). There is also a high rate of unintended pregnancies and an unmet need for family planning.
Catherine was born on 18 March 2011 weighing 3.7 kilograms. In February 2014, she weighed 17.2 kilograms with no record of frequent sickness, although she has had malaria twice since her birth.
"God is mysterious," says Chikondi. "I've exclusively breastfed my children, then fed them with locally available foods and followed advice from hospital authorities. The outcome is that it has been possible to prevent passing on my HIV infection."
Health worker John Sumaisi says: "Chikondi received treatment to prevent passing HIV to baby Catherine while she was pregnant and giving birth. The treatment also enabled her to breastfeed safely."
Avoiding unwanted pregnancies
"Early engagement in sexual activities has its own consequences, but I have done well in contributing to zero new HIV infections among my children," says Chikondi.
After trying to start a small-scale business that didn't work out, she now relies on piece work to bring food to her table.
"I am 25 years now with three children. If I can fall in love and marry again obviously the man would need a child of his own. I encourage people who are in my situation to consider family planning methods to avoid unwanted pregnancies," says Chikondi.
Early infant diagnosis and treatment
Since June 2010, ViiV Healthcare and the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) have collaborated to strengthen early infant diagnosis and treatment in Malawi.
EGPAF has been implementing a project to improve access to antiretroviral treatment for infants and young children in seven sites in Lilongwe, Dedza, Ntcheu, Salima and Nkhotakota districts.
Tessa Musukwa, technical officer for treatment and care at EGPAF, says HIV positive mothers can have HIV negative children but it is important to get the child's status confirmed with an HIV test. A DNA-polymerase chain reaction test is offered for infants under the age of two months to confirm diagnosis, since the HIV-exposed infants still have maternal antibodies at this age.
"The usual antibody test given to adults will only show the exposure status but not confirm infection, so it is inappropriate for infants and treatment of those in need of antiretroviral therapy," says Musukwa.
According to Musukwa, in 2013 more than 1,400 HIV-exposed infants and children were identified across the seven project sites and about 1,320, including Catherine, were tested for HIV using the DNA-PCR test.
Monthly visits by EGPAF technical officers have contributed to improved sample collection, analysis and documentation. Test results reach caregivers more rapidly and infants receive antiretroviral therapy earlier.
Despite these achievements there are still challenges, including: maintaining access to HIV-exposed infants to ensure they are given the correct treatment; shortages of HIV test kits for mothers and infants; healthcare workers not always getting results to caregivers on time; and the frequent transfer of healthcare workers.