Hope in Rasipuram
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Most HIV positive mothers are able to have infection-free babies. Dr. N.M. SAMUEL documents a `success story' in interior Tamil Nadu.
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RAMESH SHARMA
OCTOBER 16, 2004,was an important day for 18-year-old Primigravida Viswa. She was to visit an antenatal clinic in Rasipuram.
Rasipuram, 35 km from Salem, Tamil Nadu, has a population of 3.5 million.
Viswa soon reached there and she could see a fleet of cars and jeeps headed towards the hospital, which made her curious. There were Ministers, well-dressed men and women as well as police personnel.
On the first floor of the clinic, she found the nurses, counsellors, laboratory technicians and doctors waiting for the dedication ceremony of the Prevention of Mother-To-Child Transmission (PMTCT) facility in the hospital.
Viswa was asked to go to the counselling room to watch a video film depicting the mode of transmission of the HIV virus from mother to infant, the importance of HIV testing in pregnant women and the risks involved in breast feeding an infected infant. The video was presented in Tamil by Tamil film actresses Revathi and Rohini. The actresses were dressed in simple cotton saris and sat alongside a group of rural women. Viswa could identify herself with them.
Viswa was able to comprehend the messages in this video, in contrast to a similar message, which she had heard in the factory where she was employed a few days ago, which was in English. She was then given a form to obtain her "informed consent" to test her blood for HIV.
She was happy to follow the advice of "Revathi madam" whom she had heard in the video.
Viswa was taken to a sterile room where the technician drew her blood for testing. The counsellor who interviewed her explained to her that October 16 was an important day in the history of the hospital as the Ministers for Finance, Health, staff of the Tamil Nadu Dr. M.G.R. Medical University and the American Counsel General of the American Embassy along with the health attaché were on their way to the first floor to open the facility.
Viswa witnessed the opening of the PMTCT facility and then to her surprise, was introduced to the ministers and the counsel general.
The counsel general advised her to take medicines regularly and take good care of the infant when he/she arrives.
As soon as they all went down to attend the public meeting, Viswa was asked to see the doctor, who explained to her that her results were partially ready and that there were tell-tale signs of her being infected with HIV, but that this would be confirmed within a day or two.
Viswa was suddenly faced with the fear of the unknown. She started to eliminate one possibility after another and then it dawned on her that it might be her husband as she was monogamous. She was afraid to discuss these issues with her husband and other family members. She started to cry.
A facility in Namakkal
The counsellors and the lady medical officer were kind and compassionate.
The doctor asked Viswa whether she was interested in accompanying her to Namakkal, a town 40 km away from Rasipuram where the doctor has to conduct a follow-up clinic — for women infected with HIV. Some had delivered healthy uninfected infants after taking new drug regimen that is being tried in India for the first time with the help of the National Institutes of Health (NIH), U.S.
Viswa agreed. On the way she could witness more crowds. Viswa then asked the lady counsellor why so many people were gathered outside the hospital.
She was told that a PMTCT facility similar to the one in Rasipuram, was being dedicated in Namakkal. This would meet the needs of pregnant women in this district headquarters hospital. And they are waiting for the dedication ceremony.
The team from Rasipuram could not be seated in the pandal as many guests were present and the crowd was huge. In spite of the confusion, the counsellor who had met Viswa earlier in the morning spotted her and was upset to see her sad.
After the counselling session, Viswa felt much better, but the pain and sorrow of knowing one's HIV positive status is unforgettable.
She was then taken to meet the other mothers who were happy to show off their HIV-free infants. Viswa was calm and seemed to accept the inevitable.
On her way back, she asked the doctor: "Do you think my baby will be normal without HIV infection if I take medicines regularly?" The doctor assured her in the affirmative.
As the car reached Rasipuram, Viswa thanked the doctor and said: "Oh, I don't know how to tell my husband and his family about my test results."
There are several women like Viswa who are infected by their partners unknowingly but their infants are free from HIV because of the treatments that are available for pregnant women to take during the period of pregnancy. This is truly a success story in medical history. With the passage of time, the regimens are being refined at a rapid pace that promises to bring hope to those infected.
Other centres
Five days later Viswa came to the PMTCT clinic in Namakkal to inform the doctor that she would be staying with her parents in Thiruchengode and enquired if such facilities were available for the delivery as in Namakkal and Rasipuram.
The counsellors and the team told her that she could go to the PMTCT clinic in Thiruchengode hospital and seek their services. (The Elizabeth Glaser Paediatric AIDS Foundation (EGPAF), U.S., supports these services.
She was happy to inform the doctor that her husband was empathetic. (Many seropositive women have a different story to tell about the ill-treatment they face from family members upon hearing the positive test results).
International support
The T.N. Dr. M.G.R. Medical University in Chennai with the support from three international agencies (EGPAF, NIH and the University of Washington, Seattle, U.S.) and the Government of Tamil Nadu is providing PMTCT services at the district level and is to take the services down to the taluk and primary health centre level in Namakkal district. In 2003, the prevalence of HIV infection among pregnant women was four per cent in this district and in 2004 it has dropped to 2.8 per cent.
By these services, several positive women are able to deliver "HIV infection-free infants" and the PMTCT programme is a "success story" in the prevention of HIV/AIDS.
Dr. N.M. Samuel is Professor, Department of Experimental Medicine and AIDS Research Centre, T.N. Dr. M.G.R. Medical University, Chennai.
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