Newsletter GRANDIR | La lettre d’information sur le VIH pédiatrique en Afrique

« How should we feed our baby? » is always a « tough question » but, Dr. Andrée Bassuka (paediatrician and nutritionist at Espoir Vie Togo - EVT) offers some answers.

Headphones on her ears, Dr. Bassuka is a guest on ‘Radio Maria Togo’, a faith-based radio station in Lomé. Sister Sophie Deogratis Kpodzo and Jean-Marie Alley (psychologist at EVT) host a weekly program on HIV/AIDS. The purpose is to give radio listeners in and around Lomé, Kpalimé, Kara information on, and a chance to speak about HIV/AIDS. The program regularly talks about prevention of mother to child transmission and pediatric care of children living with HIV. Today’s topic is infant feeding options for pregnant women who are living with HIV. Over the course of the hour Sister Sophie will ask Dr. Bassuka questions and the Doctor will answer in French. Jean-Marie Alley will simultaneously translate the show into Mina.

The doctor starts out by reminding everyone how important it is for pregnant women to be tested for HIV, and reviews the measures to take to reduce the risk of transmitting the virus to one’s baby during pregnancy, labour and delivery. Then she lists the advantages and disadvantages of different infant feeding methods for mothers living with HIV: exclusive breastfeeding until the baby is no older than 6 months or replacement feeding. While breast milk is « free and readily available », it presents a risk of transmitting HIV to the child, Dr. Bassuka stresses. Infant formula, on the other hand, presents a cost issue and it also requires rigorous cleanliness and hygiene as well as access to safe drinking water… The mother’s environment comes into play as well: « Women are more likely to breastfeed their babies to avoid negative attention from those around them, underscores Dr. Bassuka. It is however possible to choose to feed your infant formula and prepare answers to the questions such as "Why aren’t you breastfeeding your child?" ».

Throughout the course of the radio program, her message is clear: it is important to weigh the pros and cons of each method and to make a choice before giving birth. She stresses that pregnant women can benefit from resources provided by any one of the 34 PTMCT sites in Togo. A listener calls in to ask about PTMCT in « remote areas ». Their advice: you should do everything you can to get to a PMTCT site --even when you live in a rural area-- in order to access necessary information and also to contact local HIV/AIDS organizations. This is an opportunity to let people know that these organizations can provide infant formula to families and can also provide medical care and treatment to children.

Dr. Bassuka wraps up by sending the following message to fathers: « It takes two to make a child and fathers are often absent when the choice of feeding this child is taken, but it’s a decision that should also be made by two! »

In the same way that we told you in Growing Up Info issue #5 about the 7 briefing notes on OVCs of the « Building Blocks » collection, we’d like to let you know about an 8th briefing note published by the International HIV/AIDS Alliance entitled: « Young children and HIV – Strengthening Family and Community Support ». This briefing note, focusing on children under 8 years old, gives practical advice to help communities and families better care for children infected or affected by HIV. It is divided into two sections: « Meeting the developmental needs of young children with HIV or affected by HIV» and « Care and treatment of young children with HIV». This briefing note is a useful tool with key points, principles and strategies in both sections.

Arsène Adonon, (Racines – Centre ADIS - Cotonou) sent us the following case study: “A boy around 7 years old is referred to the ADIS center in Cotonou by the national pneumo-phtisiology clinic. He arrives accompanied by a person claiming to be his aunt who brings them his HIV+ test result as well as a CD4 count of 123. As the admittance interview at the ADIS center progresses, it is discovered that the woman who has brought him there is not actually the child's relative. The woman and the child's mother were hospital roommates and before she died, the child's mother asked the woman to take care of her child. What should the ADIS staff do in this situation?”

Below is a combined summary of the many answers that were sent in, including Arsene’s.

”The priority is the child’s health considering the severity of his immunodeficiency. Do an HIV test immediately to confirm diagnosis and above all begin necessary therapies (treating opportunistic infections, conducting additional lab tests, providing nutritional support if necessary as well as ART).
The social workers at ADIS should do all they can to make the boy and the woman feel comfortable and to win their trust. The child’s family situation is a sensitive issue and it is possible that the woman did not tell the whole truth. Because the woman has provided unclear information regarding her relationship to the boy, staff should consult with her individually. They should also interview the boy individually. Staff should be careful not to give the impression that they doubt the information the woman has provided. Both the woman and the child should be asked separately whether the boy has any aunts, uncles, grandparents or other members of his extended family who have been reached and are aware of the boy’s situation and whether they have been consulted about who might take care of him. Staff should then evaluate whether members of the extended family are aware of the mother’s illness and if a family tie between them and the boy can be reestablished. All of these questions need to be explored with a lot of patience. An interview that is too direct could result in scaring away the woman entirely.
Staff should also visit the woman’s home to establish whether she is equipped to care for the child. Caring for a child in this state of health is a demanding responsibility and requires special attention from the caregiver. If she needs help in caring for the child, she should be advised to ask for support from an NGO specialized in orphan care.
Once the child’s health has improved staff should help him come to understand his family history with help from a therapist.”

New case study: Preventing violence against HIV+ pregnant women

You have just revealed to Fatou, a young woman who is 4 months pregnant, that she has HIV. During the course of your consultation you broach the subject of telling her partner she has HIV by explaining to her the importance of letting him know and encouraging him to get tested too. Fatou dissolves into tears and tells you that she cannot tell him because she is afraid of him because he can be violent. She describes that last year he violently chased his cousin out of his home when the latter revealed that she had HIV. In light of what she has just told you and considering how she feels, how should you counsel her?