Interview with mothers2mothers: Progress in the prevention of mother-to-child HIV transmission


In observance of World AIDS Day 2010, HNN interviewed the founders of mothers2mothers, a multinational NGO in Sub-Saharan Africa aimed to reduce the number of babies born with HIV and help women access medical care for themselves and their families. Read what m2m’s founders, Dr. Mitchell Besser, Gene Falk, and Robin Smalley shared with us.



What is PMTCT? How does it work?

PMTCT is the prevention of mother-to-child transmission of HIV – more than a method of health care, it’s a way of delivering hope.

Women are disproportionately affected by the AIDS epidemic, and no region in the world is more severely affected than Sub-Saharan Africa. In 2007, 61% of the region’s 1.7 million new HIV infections were among women.

Almost all new HIV infections among children are passed from their HIV-positive mothers. Interventions to prevent mother-to-child transmission include testing for HIV, mothers taking antiretroviral (ARV) medication during pregnancy and babies receiving the medication after they are born, delivering the baby in a healthcare facility, choosing an appropriate infant feeding method, and providing prophylactic ARVs to the mother or baby if breastfeeding is chosen. Without intervention, the chances of an HIV-positive woman transmitting the virus to her baby may be as high as 40 percent. As effective interventions for PMTCT become increasingly available, this risk has been reduced to less than two percent in well-resourced settings and less than five percent in resource-constrained settings.

You started mothers2mothers because you noticed that pregnant women living with HIV/AIDS were often not taking advantage of PMTCT treatments when offered to them. How does mothers2mothers work to address this issue?

Pregnant women newly diagnosed with HIV face paralyzing stigma that makes them less likely to seek help and adhere to medication, and a broken medical system that is stretched too thin to educate them on how to keep their babies healthy. mothers2mothers (m2m) fills this gap by creating a new kind of health care provider, whom we call Mentor Mothers, who are specially equipped to provide the missing critical support. Since 2001, m2m has operated a sustainable model of peer-based psychosocial support. By employing mothers living with HIV as peer educators and care providers, and placing these Mentor Mothers in existing health facilities, m2m enhances the delivery and effectiveness of other PMTCT services. The program acts as a critical entry point to care for women who are dealing with a life-transforming experience and may otherwise not seek or get care.

What are some of the ways “Mentor Mothers” encourage HIV-positive pregnant women to receive PMTCT treatment?

m2m provides education and support to HIV-positive women from the moment they are diagnosed as HIV-positive to the day they deliver, and beyond.

Mentor Mothers begin by providing HIV counseling and testing to all women at their first prenatal care visit, conducting individual education and support for HIV testing, and making referrals to ongoing m2m support groups.

Individual and group support activities are designed to increase women’s knowledge, understanding, and acceptance of their HIV status. Mentor mothers help women understand how to take the ARV medicines during pregnancy for PMTCT, provide individualized counseling on infant feeding, and talk about safer sex practices and disclosure of HIV status to partners and family. These are education components that medical providers are often too busy to undertake.

After delivery, Mentor Mothers help ensure that newborns receive preventive ARV therapy before discharge, guide mothers in deciding how to feed their infants, and encourage mothers to return for follow-up visits at the clinic and m2m groups. New mothers are also encouraged to return to the clinic with their babies for HIV testing, continued support for breastfeeding mothers, family planning, and ongoing HIV care.

Finally, Mentor Mothers can visit women at home to provide additional support where necessary, including helping them disclose their HIV status to family and providing emotional support to the women and education to their partners, family and friends.

How can the mothers2mothers model be replicated and scaled up? How can “Mentor Mothers” become integrated into a national health system?

From its beginnings at a single clinic in South Africa in 2001, m2m now offers services at 696 sites across nine countries in Sub-Saharan Africa. On average, over 200,000 client interactions take place every month, and 300,000 new HIV-positive mothers enrolled in the program in 2009. We are continually looking for ways to effectively scale this model to reach more communities and more women.

Each country where m2m operates may have a different set of needs and priorities, so m2m has developed a portfolio of delivery models to address each country’s requirements and allow the Mentor Mother program to contribute to strengthening the local health system.

As we mark World AIDS Day this year, how much progress do you think the global health community has made in terms of preventing mother-to-child transmission of HIV? What has improved, and what needs more work?

Mother-to-child transmission is almost entirely preventable when PMTCT services are accessed – we know this is true because it’s almost non-existent in developed countries. But the actual uptake of these services in the developing world remains low. This is due in part to weaknesses in the systems that deliver PMTCT care. For years, the focus of PMTCT has been strictly on clinical interventions, which means less attention is paid to the types of support that address the psychosocial impact of HIV. We need to focus more on the social and cultural barriers that prevent pregnant women from accepting HIV testing, treatment, and infant feeding methods that can prevent the transmission of HIV. To accomplish that goal, health systems will need to be strengthened with non-medical personnel who understand the unique challenges faced by pregnant women living with HIV and can guide them to the clinical care that they need.

>Visit m2m’s website to find out more about their great work

>Check out the latest UNICEF report outlining progress made on PMTCT

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