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Checking mother-to-child HIV transmission
Shen Junhong, a 35-year-old rural woman, cannot forget how she suffered in the 30 minutes she waited for an HIV test in the People's Hospital of Shangcai, Central China's Henan Province. "I leaned against the wall outside the testing room. My legs were trembling so severely that I could hardly stand," she said. She was awaiting the test result for her 18-month-old son. When she was informed that her son was not infected, her tears streamed down. Shangcai hit the headlines in the late 1990s as AIDS spread in the county through contaminated blood donations. No official statistics are available to reveal how many HIV positive villagers live in the county with a population of 110,000, but local doctors estimate the number could be over 5,000. A villager of Kanhualou in Shangcai, Shen was diagnosed as HIV positive in a prenatal examination before giving birth to her twin daughters in 2000. One of the girls was also infected in delivery. Since then, Shen and her husband, 34-year-old Zhai Guochun, stopped having sex and began to live separately. But occasionally when Zhai got drunk, he slept with his wife, and Shen became pregnant again in 2001. She refused to give up the baby. "I want a son," she said. Thankfully, local doctors came to her aid and conducted an intervention of mother-to-child AIDS transmission. Before delivery in January 2002, Shen was asked to take medication called Viramune. Her baby also received a dose of the same medication upon birth. She had a Caesarean section to deliver her baby son and was given milk powder to feed him for six months. The medicine, operation and powdered milk are all free of charge. As one of the three transmission channels of AIDS, along with blood and sex, the mother-to-child transmission rate has increased rapidly in China in past years, from 0.001 per cent of all the HIV/AIDS infections in 1997 to 0.6 per cent in 2003, says Dr Wang Linhong, deputy director of the National Centre for Women and Children's Health of China's Centre of Disease Control and Prevention. In regions such as Shangcai, where the situation is more serious, the rate could be even higher. An infant is likely to get the deadly virus from its mother at three stages: pregnancy, delivery and breastfeeding, with the second stage most risky. Without intervention, the chance of transmission averages 15 to 35 per cent. But, according to Dr Wang, one third to half of the infections happen during the delivery period. Therefore, great efforts have been made to check delivery transmission. Since October 2001, experimental intervention sponsored by the United Nations Children's Fund has been carried out in the seven most seriously plagued villages of Shangcai, said Han Boyong, head of the Women and Children's Healthcare Centre of Shangcai. By June 2003, intervention had extended to all the 25 villages in the county, and a supervisory group for the intervention work had been formed. Pregnant women diagnosed as HIV positive in the prenatal examination could make a choice whether they wanted to keep the baby or not. For those who wanted to, the prevention method as it was done to Shen is carried out. They are asked to take 200 mg of Viramune two hours before delivery, and the baby is fed with 2mg to 6mg of the drug in accordance to its weight within the first 72 hours of birth. Three hospitals in Shangcai County, including the People's Hospital, provide the intervention service, with special operating tables and wards for HIV positive mothers. "In examinations or Caesarean operations," said Han, "certain steps, like feotoscope detection and amniocentesis, which are likely to expose the baby to his mother's body fluid, should be handled cautiously." After the mothers return home with their newborns, doctors like Chen Jinrong with the People's Hospital of Shangcai, go and visit them, often on their bikes, bringing them formula milk and checking the physical condition of both the mother and the baby. "When they are reluctant to reveal their illness, we have to pretend to be their relatives or fix another place for the appointment," says Chen. Working in the hospital since 1989, she remembers that when she first came into contact with HIV carriers in 2001, she felt afraid despite using barrier nursing methods. "You can't anticipate whether the contagious amniotic fluid or blood of the patients would spout out," she says. But when later the grateful mothers clutched her hands or even knelt before her in tears, she was overwhelmed by a sense of mission. The doctor has until now helped deliver 10 babies of HIV positive mothers. To date, more than 60 HIV positive women have received medical intervention in Shangcai. Because of technical limitations, local hospitals could only detect if a child was HIV positive via an antibody test after he is 18 months old. Fortunately, the 18 babies older than 18 months born after intervention are all HIV negative. Yet the method cannot check transmission in all cases. "As this project was carried out in 2001 and the period is not long enough, we couldn't calculate the probability of success with current data," says Dr Wang, adding that in theory, the success rate is 50 per cent. Besides, Wang is worried about the side effects of Viramune, which is reported to cause hepatitis, skin diseases and medical resistance in patients. That's why Wu Zhongren, a medic with the clinic of Guotun, a village where 10 per cent of the 1,476 residents are infected, often discourages pregnant women with HIV from keeping their babies. "As a medical worker with nearly 40 years of professional experience, I feel rather sorrowful to see my neighbours struggle in pain, their families break up, and their children become orphans," he says. "Their living standard is not very high, so if their children become infected, they have to spend more money because of the disease; even if they are healthy, rearing a child aggravates the already heavy burden of the parents." Wang Lin, 33, had heeded Wu's advice. Already having a son, Wang and her husband, both HIV positive, longed for a daughter, and she got pregnant in the spring of 2004. "As a mother, I should be responsible for my child," she says. "Now that we are unable to work because of the illness, how could we support her if she is HIV positive too?" Wang has joined the village's waist drum team, which was formed in September 2004 by HIV positive villagers. "By keeping ourselves fit and doing more exercise, I will fight the disease as long as I can," she smiles. Her son is now a third-grader in the local primary school. "I see him entering university and marrying a beautiful girl." And Shen Junhong, the HIV positive mother, named her son Taiping, meaning "peaceful and safe." "I just want him to be safe and healthy," she says. |
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