‘The need to produce children is there’

“When I am walking nobody knows that I am HIV positive. I could marry and father children with a woman who is HIV positive or negative. The need to produce children is there. But we need children who are HIV negative. That is why we are advocating for PMTCT [preventing mother to child transmission services] and are asking you that you channel mothers to deliver in health facilities.”

So spoke Henry Kimuli, the chairperson of the Kalagala Group of People Living with HIV (Kalagala PHA) in Luwero at an event organised by the grounp to encourage men to understand the importance of testing for HIV and using PMTCT services if they need to.

The need for PMTCT

Kimuli, who is himself living positively with HIV, told the audience of opinion leaders, church leaders, village health team members, local people, traditional birth attendants, community development officers and community elders that he was “a living case of HIV” in his community.

He added: “I am talking to you because I know how painful HIV management is. It is also my responsibility as a person living with HIV to tell you because I know the benefits of having a child who is born free from HIV.”

Henry told those gathered that his organisation is not preventing people from producing children when they appeal to them to plan for their families, adding: “We are merely asking the parents, especially those that are HIV positive, to plan and produce the children they can manage and take care of.”

What local leaders say about PMTCT

Local leader Mr. Kategaya Livingstone Ssembatya, who attended the event, said: “It is unfortunate as we hear from the radio and newspapers that HIV is increasing so much among the married couples, who are the ones producing our children. This engagement has come at a great moment because the couples that live in Kamiira sub county will get an opportunity to get tested and then see whether they can benefit from this PMTCT project.”

Church leader Wasswa John from Kabukuga Open Bible Church, which has more than 200 followers, noted that: “It is important as church leaders to know about PMTCT. For us, as we pray for the Christian laity, this knowledge will help us to advise them on alternative health options, especially for HIV positive women that are pregnant. This engagement has helped me to know where to stop when preaching to the sick.”

Ssentongo Appollo, an assistant nursing officer at Kamiira Health Centre IV, said: “I am very happy that for the first time I am in a meeting with traditional birth attendants.

“I am addressing myself to you TBAs: we as health workers are happy with the good work that you are doing in the villages but we have realised that most mothers come to us for all the antenatal care, but then chose your services for delivery. Fine. But please, after she has delivered, send the mother to a health facility. Let us also attend to her after she has delivered. We could save the babies.

“Secondly, there are so many children that have been delivered in your hands and are in the villages, please send them over for immunisation.”

Why we need men in PMTCT

Nassanga Babra, of Kalagala PHA, said there is no way PMTCT can succeed if men leave women to go through it alone.

“It is our duty as a community to encourage the men to get more involved…we can do this by leading by example. Sometimes a HIV positive woman gives birth when her CD4 count is very low and the health workers may advise against breast feeding. If the husbands are not aware of such a situation it may bring conflict in the family as the husband may wonder why the child is not being breastfed. In addition, the father may be required in the provision of supplementary feeds for the child.

“We are telling men to come on board because they are the steering wheel of the family. We need them to be beside their wives as they make the most difference in our strategy towards zero new infections.

“We have realised that for most men, when they are tested for HIV and found to be positive, they do not take the results home. Even some women who are tested for HIV and found to be HIV positive do not easily share their test results with their husbands.”

Some challenges

Health worker Ssejjemba Robert said he did not blame the TBAs for low take up of PMTCT services because, in some communtities, having traditional births is central to people’s mindsets.

“You find that in a given community a particular TBA facilitated the birth of a certain mother, the children, the grandchildren and in some cases the great grandchildren. In such a situation it is very difficult to convince a family not to employ the services of a TBA or…that children delivered by a TBA should again be referred to a health centre.”

The event is part of a larger community engagement drive that will see Kalagala PHA hold various discussions on the challenges of PMTCT referral across the district . A drama on the subject set at Kamiira sub county Health Centre IV is also being planned.

Their work is part of a three year PMTCT community referral strengthening project run by Community Health Alliance Uganda with funding from ViiV HealthCare’s Positive Action for Children Fund.