Maputo, Mozambique—Sandra Bento Nuvunga, the mother of two boys, knows the fears and joys that come with being an HIV-positive parent. Her own personal journey began in 2006 when, pregnant for the first time, she learned that she also carried the virus that causes AIDS. Despite her shock and dismay, she rallied her beleaguered spirit and enrolled in prenatal care and treatment at Chamanculo General Hospital, even as the father of her unborn child abandoned her.
Sandra went on to give birth to a healthy baby boy who would test negative for HIV, the best news any mother could receive. Her experience and the high quality of care she received at Chamanculo led Sandra to join the facility as an “expert patient activist” who helps women living with HIV to maintain their health during pregnancy and give birth to HIV-free children.
“PMTCT [prevention of mother-to-child transmission] is such an important program,” Sandra said recently, reflecting on her experience. “There is no sadder thing in life than a mother learning that her baby is HIV-positive.”
In 2013, when Sandra became pregnant again, she returned to Chamanculo. By then, the hospital had become part of the National Model Maternity Initiative, an approach that emphasizes the fundamental rights of the mother, newborn and families. The initiative is sponsored by the Mozambican Ministry of Health with support from the U.S. Agency for International Development’s flagship Maternal and Child Health Integrated Program (MCHIP). Jhpiego, which leads the MCHIP global award, has been working in Mozambique since 2004 to prevent the needless deaths of women and their families. In partnership with the government, Jhpiego focuses on maternal and child health, HIV/AIDS, tuberculosis and infection prevention, developing innovative solutions to today’s health challenges and ensuring access to quality health services.
The Model Maternity Initiative promotes birthing practices that recognize a woman’s preferences and needs and focuses on humanistic care and the scaling-up of high-impact interventions, including a strong focus on PMTCT. More than 270,000 women have received HIV counseling and testing for PMTCT and their test results at Model Maternity Initiative facilities. During the period April to June 2013, 95 percent of pregnant women presenting at their first antenatal care visit were tested for HIV.
In addition, more than 26,000 HIV-positive pregnant women have received antiretroviral therapy to reduce the risk of mother-to-child transmission. During the period April to June 2013, 96 percent of HIV-positive pregnant women were on antiretroviral drugs at the time of delivery, with 91 percent of these on a three-drug regimen.
In addition, clients receive counseling on healthy birth spacing and family planning options following the birth of their baby—including the option of postpartum family planning for HIV-positive mothers. Since April 2011, 643,869 family planning consultations have been carried out at facilities involved in the Model Maternity Initiative. As a result of these services, 230,313 women (HIV-positive and HIV-negative) received a new family planning method, and 339,129 women continued to use a family planning method of their choice.
Sandra, who now counsels patients on antiretroviral treatment, recognizes the important role patient activists can play in educating women and their partners on maintaining a healthy lifestyle to prevent transmission of HIV to an unborn child. She candidly recalls her own experience learning that she was HIV-positive. “It wasn’t until I arrived home that I started to think on what the positive result meant for me,” she says. “I spent two months at home crying, and even thinking about taking my own life.”
After a long period of reflection, she pulled together the strength to return to Chamanculo General Hospital and start prenatal care again, determined to do what was best for her baby. She repeated the HIV test, had her CD4 count measured and began taking antiretroviral therapy. She gave birth to her son on November 9, 2006, and named him Eugio, meaning “intelligence.” Eugio received nevirapine when he was born, but at this point in the epidemic it was not possible to know his status until his first birthday.
“I was sure that he was HIV-positive because he stopped gaining enough weight around seven months,” Sandra explains. “This period was the most difficult in my life—waiting and wanting to know his status, but at the same time not wanting to know because I didn’t want a positive result.”
On Eugio’s first birthday, in 2007, she took him for his HIV test. The result was negative, and the young mother rejoiced. She became pregnant again in 2010 and re-enrolled in prenatal care at Chamanculo.
“They [the nurses] treated me so well at the hospital,” she says, and in April, she gave birth to another baby boy, Mamisse. This time, she did not need to wait a whole year to learn his HIV status. In May 2010, she took him for testing and learned that he, too, was negative.
Mamisse and Eugio are now three and seven years old, both healthy, energetic little boys. Eugio loves toy cars and going to school, while Mamisse keeps Sandra busy chasing him around. Sandra continues her work with Chamanculo General Hospital, a real-life example of the benefits of PMTCT.
“I like to share my story with others and show that you can lead a healthy life by adhering to treatment,” she says.
Sandra Bento Nuvunga (pictured above) thanks the Model Maternities Initiative for its help in preventing transmission of HIV to her youngest son. Photo: Jhpiego