FOUR-YEAR-OLD Nokutenda playfully tugs at her father’s ear and scampers off giggling. She skips about in the dimly-lit mud and pole hut in Nhema village, Shurugwi. Her eyes shine with excitement.
Her parents, Patrick and Mildred Makontos, fondly gaze at their daughter, whom they regard as a miracle.
“She has given hope to other HIV positive couples who were afraid of having children,” Mildred explains.
Patrick, a teacher at the village high school, Gare High, tested positive for HIV in 2003.
“My wife used to carry me in a wheelbarrow all the way to the clinic,” he says, eyes fixed on the ground.
Patrick began anti-retroviral therapy (ART) and his health improved. Studies have shown that ART prevents HIV from multiplying and, therefore, keeps the amount of virus in an HIV-infected person’s body under control.
Patrick’s work colleagues and fellow villagers, however, shunned him. Some even suggested that he resign himself to his fate and go home to die peacefully.
Despite the discrimination, Patrick, who was bedridden at the time, started taking his medication as prescribed and soon showed signs of life. He returned to work afterwards.
In 2004, after taking an HIV test, Mildred was shocked to discover that she too had the virus.
“I was scared, angry and hurt,” she says, recounting memories of friends discarding a cup she had used to drink water. “People discriminated against me.”
After counselling and encouragement, she accepted her status and fought against the stigma.
About eight years after Patrick started ART, the Makontos decided to have another child, but those close to them warned them that their child would be born with HIV.
At the time, Zimbabwe still had one of the highest burdens of new HIV infections. Around 30% of all babies born to HIV-infected mothers in the country in 2009 were either born with the virus, or became HIV positive during breastfeeding, according to Zimbabwe’s United Nations (UN) progress report of 2014.
The World Health Organisation says without medical intervention, women who are HIV positive have between a 15% and 45% chance of passing the virus on to their babies during pregnancy, delivery or breastfeeding.
However, tables turned when two global health organisations, the Elizabeth Glaser Pediatric Aids Foundation (EGPAF) and the Children’s Investment Fund Foundation (CIFF), joined the Health ministry in rolling out the Virtual Elimination of HIV Infection in Infants and Young Children project.
A $45 million grant was awarded to support the government’s five-year programme for the prevention of mother-to-child transmission of HIV, also known as PMTCT.
There was strengthened capacity of PMTCT projects at national, district and community levels. Health care providers were trained to manage PMTCT patients.
PMTCT sites were increased from three in 1999 to 1 495 sites in 62 districts of Zimbabwe, providing 96% coverage of the country’s 1 560 antenatal care sites.
This has meant more and better treatment for HIV positive mothers. According to the Global Aids Response Country Progress, PMTCT drugs were made more widely available and nurses received intensive training on the issue, making it easier for the women to get treatment without having to travel to the urban health facilities.
According to the 2014 Global Aids Response Country Progress Report, 93% of pregnant mothers living with HIV in Zimbabwe had access to comprehensive PMTCT services and 15 000 HIV infections were averted this way.
High quality, comprehensive PMTCT services are now provided in 95% of the 1 560 health facilities in Zimbabwe. This has meant more and better treatment for HIV positive mothers.
So when the Makontos approached staff at Chikwingwizha Clinic, they were told that there was hope that their baby could be born HIV negative, if they followed the treatment procedures of the clinics PMTCT programme.
“The first step, the nurse said, was to make sure our CD-4 counts were not too low,” Mildred says.
A CD-4 count measures the strength of someone’s immune system. HIV-infected people, who are not on ART, usually have low CD-4 counts, because their immune systems have been weakened by the virus.
“When we counsel HIV positive couples who want to try for a baby, we emphasise that their CD-4 count should be in the normal range, between 400 and 1 200,” a nurse, Miriam Mushati, from the Chikwingwizha Clinic, says.
Mildred’s CD-4 count was within acceptable range, but Patrick had to keep taking his medication until his was well above 500, and the Makontos started trying for a baby.
“When I realised I was pregnant in 2012, we knew that if we took better care of our health and Patrick continued to take his drugs, we were less likely to have an HIV-positive baby,” she says.
When Mildred started visiting the Chikwingwizha clinic for her antenatal check-ups, the clinic staff explained the PMTCT treatment guidelines, which included practising safe sex and eating healthy foods and adhering to treatment.
But in 2011 Zimbabwe adopted the World Health Organisation’s (WHO’s) 2010 PMTCT guidelines, which recommended, among other things, that women begin receiving ARVs from 14 weeks into their pregnancy.
The new guidelines improved the mothers’ health and reduced the risk of transmitting HIV from mother to child to 5% or less.
In 2014, Zimbabwe adopted the WHO’s 2013 guidelines for PMTCT, known as “Option B+”, which recommends lifelong ART for all HIV positive pregnant and breastfeeding women, regardless of CD-4 count.
She gave birth to Nokutenda after a few hours of labour.
After delivery, Mildred was shown how to breastfeed, and instructed to practice exclusive breastfeeding until her daughter was six months old.
This meant she wasn’t allowed to give her baby anything other than breast milk for six months — not even water.
Nokutenda received Nevirapine syrup until she was six weeks old. She was put on cotrimoxazole, which she took daily until she was six months old and had her first HIV test which was negative.
WHO recommends that HIV-exposed, but uninfected infants get cotrimoxazole (CTX) prophylaxis from the age of four to six weeks until they are no longer exposed to HIV and have confirmation of being HIV negative. Cotrimoxazole is a highly effective antibiotic against pneumonia and other opportunistic infections.
Nokutenda was again tested when she was two, and her result was negative.
“I was so happy. The community learned that an HIV-positive mother can give birth to an HIV-negative baby,” Mildred says.
Patrick is speechless when asked how he felt about his daughter being HIV negative.
“I cannot believe it some times that this beautiful child is part of me. It makes me happy and proud that we did this for her,” Patrick says, as he hugs a sleepy Nokutenda and draws her gently to his chest.
He hopes to live long enough to see her graduate from college.
The Makontos were one of the first couples to openly declare their HIV status and today, remain in the forefront fighting stigma.