Cape Town — At 9 a.m. each morning and 9 p.m. each evening, in her shack on the outskirts of Cape Town, Nomsa* diligently takes the antiretroviral medication that makes her HIV-positive status a manageable condition rather than a death sentence. But over the past month, her morning routine has changed.
Since giving birth to a baby girl, not only does Nomsa take her own medicine, but she also doses her newborn with a special paediatric formula of anti-retroviral syrup.
"She loves her food, and she loves the syrup. It's sweet," says Nomsa of the dark-haired baby in her arms, wrapped warmly against the cold Cape Town winter and drinking from a bottle of formula feed.
Nomsa is one of the many women enrolled in the Prevention of Mother to Child Transmission programme in Site B, Khayelitsha – a hospital where the medical humanitarian organisation Médecins Sans Frontières (MSF), together with the provincial government, pioneered Aids treatment and prevention here more than a decade ago. South Africa has the largest number of people living with Aids of any country, and 30 per cent of pregnant women tested HIV positive in 2009.
Measures that block transmission of the virus that causes Aids from mothers to their babies has been one of the hotly debated topics at the 2012 World Aids Conference in Washington D.C. this week. Programmes that test all pregnant women and treat those who test positive, followed by preventive treatment for their newborns, have mostly eliminated cases of newborn Aids in developed countries. But more than 40,000 South African babies a year get the disease, and half of them will die, according to Unicef, the World Health Organisation.
The hopeful theme of this week's Aids conference is "Turning the Tide" against the disease. And In South Africa, the sea change is visible - in certain areas.
The Maternal Obstetric Unit in Site B, Khayelitsha is one of those places. In a country where deaths of mothers from complications of pregnancy and childbirth have climbed rather than crumbled, largely due to HIV, not a single maternal death was recorded from April 2011 to May this year.This bucks the trend that has seen South Africa's maternal mortality rate quadruple over the past two decades.
By contrast, the country has made progress in reducing the rate of mother-to-child transmission of HIV, from eight percent in 2008 to 3.5 percent in 2010 and to 2.7 percent in 2011. The efforts of health workers and authorities here in Khayelitsha - and the financial and human resources they have available - demonstrate what can be accomplished.
In February 2006, Nomsa tested positive for HIV. Her T-cell count – the cells that fight infection – had dropped. Her viral load – the amount of the HI virus in her blood – was dangerously high. Two months later she started antiretroviral therapy.
The first-line drug regimen helped her T-cells to recover, boosting her body's ability to combat infections, but her viral load remained high. Three years later, in 2009, doctors put Nomsa on second-line antiretroviral therapy, a stronger cocktail of drugs, which ensured that her viral load dropped significantly.
It was at this point that Nomsa decided she would like to have another child. Her older daughter, who is now 13, is HIV-negative, born before Nomsa contracted the virus.
"I was scared to have a baby because of my status, but I got the information that even if you are [HIV]-positive, you can have a negative child," she said. "And some of my friends, they had a negative child."
An important source of information and support, says Nomsa, is her membership in the Treatment Action Campaign – a vibrant non-profit organisation in South Africa that advocates for the rights of HIV-positive people. She also attends bi-monthly meetings of the local "Adherence Club" where people on antiretroviral therapy monitor their weight, can discuss their health complications, and all being well, receive their two-month supply of antiretroviral drugs.
These social structures are important factors in the environment in which an effective Prevention of Mother to Child Transmission (PMTCT) programme operates.
All too often the focus of PMTCT is on ensuring that babies are not infected with HIV, when in fact, the programme needs other legs to stand upon. These include the prevention of HIV infection among young people and pregnant women, as well as the prevention of unintended pregnancies.
"I talked to my doctor before I got pregnant," said Nomsa. "My doctor said it was fine because my viral load is undetectable and my CD4 count is ok."
As soon as she realised she was pregnant, Nomsa booked in at the maternal obstetric unit in Site B where she was carefully monitored throughout her pregnancy.
"I told them I was HIV-positive, but they wanted to test me again. They also took my CD4 count, and they were a bit surprised, because it had dropped from 515 down to 215," she said. "They advised me to breastfeed the baby, but I was scared because of my low CD4 count, and so I said, 'No, I'm going to use the bottle'. They also did a pap smear to check for cancer, and even checked for syphilis. Everything was ok. "
On June 29, Nomsa gave birth to a baby girl. Now she is living in limbo as she counts off the six-week period to see whether her infant is HIV-free or not.
"I'm going to test my baby on August 10th.," she said. "I'm only a little bit nervous, because when I was pregnant I was taking my treatment properly." Now she is maintaining her own strict, lifelong medication routine and diligently dispensing her daughter's six-week antiretroviral course as well.
Nomsa has good reason to believe her daughter will be HIV-negative, says Dr. Vivian Cox, MSF's deputy medical field coordinator in Khayelitsha. The issue for the global Aids community is whether that encouraging prospect can be extended to every pregnant woman and baby facing death from Aids.
Chewe Luo, Unicef's senior advisor on HIV and Aids, told the Washington conference that despite the proven success of prevention programmes that promptly treat both pregnant women and their newborns, the global rates of mother-to-child transmission are only declining by 10 per cent a year - not fast enough for the more than 300,000 babies who are still dying annually, or for their mothers.
Luo praised Malawi, the first low-income country to adopt the recommended, most effective protocol. This protocol provides lifelong antiretroviral treatment to any HIV-positive pregnant women and largely prevents transmission to the unborn baby as well as protecting the woman and reducing maternal deaths.
But in a time of economic downturn and tightening budgets for health, Luo posed the question on many minds in Washington and across Africa - "where is the money going to come from?"
*Not her real name.