I thought I would have to go looking for stories of hope amid despair at the HIV clinic for women and children located inside the Korle-Bu Teaching Hospital in Accra, Ghana. The largest teaching hospital in Accra, Korle-Bu is on the front lines of the battle against infectious disease, but particularly HIV/AIDS. By western standards the hospital is bleak at best, with overcrowded waiting rooms and rudimentary laboratory facilities. A dedicated staff of nurses, doctors and volunteers ushered us through the facility, talking bluntly about the challenges they face daily in trying to reduce infection rates and prevent further spread of a disease that has torn through the African continent.
Then I met Doreen and Angela. Doreen is a 38 year-old married mother of two. Angela, at 10 months, is her youngest child. Doreen is HIV positive. Angela is not.
Doreen and Angela represent all that is working in the international effort to combat HIV/AIDS in Ghana. Doreen discovered she was infected with the virus during her first pregnancy eight years ago. Like other Ghanaian women, Doreen has tested positive for the virus while her husband has not. She says she has no idea how she contracted the virus or when exactly, but her body language and eagerness to shift the conversation away from her husband’s HIV status suggested otherwise. But for Doreen her HIV status is not the issue, nor is her husband’s. Her story, and the success of these public health efforts play out not only with her survival, but through her children.
Both of Doreen’s children are HIV negative thanks to the massive public health and education initiatives supported by The Global Fund and facilitated by the local Country Coordinating Mechanism (CCM). In Ghana approximately 16,000 people die from HIV/AIDS every year with 2500 of those deaths children. Approximately 2% of pregnant Ghanaian women carry the virus and it is estimated that 126,000 women and 32,000 children in Ghana currently live with HIV. Each year there are approximately 13,000 new cases of HIV reported, with 2,000 of those new patients children.
That Doreen is HIV positive but both her children are not shows that the efforts of pre-natal maternal testing and public education work. Pregnant women who are HIV positive can now start a prophylactic treatment as early as 14 weeks to prevent in utero transmission. For women who don’t know their HIV status, testing has become part of routine prenatal care, though admittedly a great number of Ghanaian women do not routinely access prenatal care. To address this challenge testing is also integrated into antenatal care with tests and checkups beginning at 2 weeks post birth.
The early intervention and testing regimen coincides with traditional antiretroviral protocols and a push to promote breast feeding among mothers. The result is that even those Ghanaian mothers who can afford formula breast feed exclusively for at least 6 months, provided their viral load permits. It’s a cultural shift that seems simple but carries profound consequences.
Talking to Doreen those cultural shift in attitudes surrounding HIV become immediately apparent. She talks openly about her status an an infected mother, her treatment regimen, life with her children, and her husband’s construction work. Living with HIV is her life, nothing more, nothing less. Her family lives just outside of Accra and she travels to the city twice a month to access her medications and for checkups. Her treatments are largely free for her, thanks entirely to the efforts and dollars of international community and work of The Global Fund. That support, she shared, is literally what keeps her alive.
Doreen’s story is a success, but a tenuous one. With the global recession and the recent decision by the Obama administration to back out of funding pledges, the community health initiatives that keep Doreen alive and that prevented transmission to her young children are in jeopardy. Ghana, like other African communities balance on the precipice with the AIDS pandemic. After years of steady success in educating Africans on transmission, reducing stigma surrounding HIV status and proving that treatments do work to keep Africans like Doreen alive, the dollars are drying up.
And when the dollars leave, so too does the hope for mothers like Doreen.
Photo © The Global Fund / Nana Kofi Acquah