Help, my wife is HIV positive!

I was in a serious relationship with a girl for two years, which was to lead to marriage. Late last year, she gave birth to a baby girl. During the two years we stayed separately but visited each other often. When she gave birth, she proposed to move into my place but being busy at work, I suggested she stay at her place for about a month since her friends could give her the much needed assistance and care. This was also to give me ample time to plan. Upon discharge, I enquired about some strange medicine she had been given meant for the baby and she told me she was HIV positive. Two weeks after this incident, we went for VCT (the three of us) where I tested negative and she tested positive. The child was not tested. This was really a very difficult time for me and we were directed to a counsellor, an idea she flatly rejected arguing that counselling won’t change anything. My problem is that I have a very strong connection to her but I am not sure if I should move on or continue with our relationship. She has refused to take ARVs and now I’m worried for our daughter. Is our daughter at risk of contracting HIV through breastfeeding? What should I do? {HRS}

Your take

Scientists suggest that the risk of infection is always present when the baby is breastfeeding. Not all mothers can infect the babies when breastfeeding. Doctors can also give some medication to protect the baby, though HIV positive mothers are advised not to breastfeed. Try and convince her to feed your baby on formula milk until the doctors say otherwise. And for you, you will be infected if you continue having sex with her and the baby will not have parents to rely on. Start protecting yourself.

{Cathy M}

I understand your girlfriend is HIV positive, but you are not. This in itself should raise an alarm, but do not make the situation worse than it is. Let her tell you the truth if this baby is yours. The alternative is to have a DNA test, but it may be very expensive. The second observation is that she does not care what happens to her or the baby. You have a responsibility to see that the baby is well taken care of. It does not matter at this stage if she is your baby or not. You can involve your parents or her parents to knock some sense into her. If you feel uncomfortable with her, then let her know and talk about it.

{Pamellah K}

This is a great challenge, which needs courage and divine power to overcome. If a child is being breastfed by a HIV+ mother, chances of infection are high. Love conquers all; so it is not impossible for you to convince her to take the drugs. It all depends on you because you are HIV– and despite her status your love for her is strong. To have a longer life with her, the solution may only be ARVs. {Danson Kighambo}

My Brother, your priority is safe life; your relation to the child is not confirmed.
If I were you, I would lend necessary assistance to the child and forget about marrying the mother because she seems not interested in taking care of herself and the baby.
{Augustine Muok}

My take

As I pondered this, two quick thoughts came to my mind; one, you need to get tested again at least two times within a span of about six months, and two, moving on with the relationship is the best gift you could give to your fiancÈe and lovely daughter. This is the biggest battle we are fighting in HIV and Aids issues, the battle of stigma and discrimination. The plain truth is that there is nothing the HIV infected people have done that we have not done. She is at her point of need where she needs tender love, attention and care. Turning your back on her will have adverse effects on her as well as your daughter and these effects will weigh heavier on the young girl.

That you have tested HIV negative does not fully ascertain your status. You had unprotected sex with her — that is how she got pregnant, right? There are two critical factors you need to be aware of before you conclude about your HIV status — the window period; and discordance. The window period is that time between infection and the emergence of detectable antibodies to the virus. This can last between three to 22 weeks depending on your body’s immune system and the type of HIV you are infected with. Yes, there is HIV1 and HIV2 but that is talk for another day.

Discordance is a state in which a couple has been engaging in unprotected sex but even after three to six tests, one party tests negative, while the other continuously tests positive. Breastfeeding

Research and statistics have established that the infection likelihood of babies born of HIV positive mothers stands at 22 per cent. Being pregnant and HIV positive does not automatically mean the baby will also be HIV positive. Babies get infected at birth (through contact with HIV infected blood). Breastfeeding only increases the possibility of infecting the baby if necessary caution is not observed. Prevention of mother to child transmission (PMTCT) is dependent on various factors, which include the discovery time of HIV status, the CD4 count, which is linked to the use of anti retro-viral (ARV) drugs, and possibility of alternative breastfeeding mechanisms for new born babies.

PMTCT at birth

The most certain approach to prevent mother-to-child transmission during birth is through cesarean delivery (C-section). Your doctor or midwife should be in a position to advice you on the possibility and success of this.

PMTCT after birth

Breastfeeding is the main mode of transmission after birth. Nonetheless, this does not imply in any way that HIV positive mothers should not breastfeed. Rather, it informs us to take precautionary measures to ensure that transmission does not happen. At birth, and where the HIV status is known to the midwife, two drugs nevarapine (viramune) and zidovudine (retrovir /ART) may be administered. Nevarapine is administered once at birth while ART is administered a week after birth. These drugs will definitely not cure or totally protect the baby from infection. They slow down multiplication of HIV, thus giving the baby’s immune system time to develop. These could have been the drugs she got after giving birth.

At birth, the mother is given two choices on breastfeeding; exclusive breastfeeding for six months or alternative feeding of the baby using manufactured products. Using alternative products is dependent on the availability, affordability, consistency and acceptability of the mother to these products. If these factors do not all work together, then it is better not to start.This, therefore, brings to light the fact that breastfeeding after birth does not necessarily infect the child. But caution should be observed for any mouth sores on the baby and any rushes or wounds on the mother’s breasts. As for you, I encourage you to have protected sex always — that is the only way of ensuring you remain HIV-.

Taurus

Many thanks to Pauline Kiamba of Kenyatta National Hospital for her valued advice on this subject.

In the next issue:

My husband says he loves me but he is always too busy to have time for me. He comes home late everyday and always goes to work early. He provides well for all my basic needs and sometimes even gives me money for picnics but I find it hard because he does not have time to accompany me. I feel neglected and whenever I try to tell him this he says that even the community, his friends and job needs him. Whenever I complain about this neglect he says he is busy working for me. This makes me feel so lonely. Is there anything I can do to make him want to spend more time with me? How can I change this? {Alice}

Dear readers,

This column appreciates that no one really has all the right answers and, therefore, seeks to get your feedback on the issues raised for discussion next week. We would appreciate to publish your comments and advice to the issue set for next week. Kindly send your views and opinions to: [email protected]

They will be published in the next issue and unless otherwise stated, contributions will be duly credited. Also, you are invited to send your burning issue for discussion in this forum.

{ email:[email protected]}