“It was the happiest moment in my life when the HIV confirmatory test result of my second newborn child came negative,” a long-term HIV survivor, Mina (name changed) said to Imphal Free Press.
Many couples living with HIV undergo a life of misery due to transmission of HIV infection from mother to child. But, now, such disheartening consequences have been addressed to a large extent in India since the implementation of the Prevention of Parent to Child Transmission (PPTCT) programme under the National AIDS Control Organisation (NACO) in the country in 2002.
The programme, aimed at boosting the confidence and providing new hope to many HIV-infected parents, was launched in Manipur in 2012.
Manipur being one of the states in India with high HIV infection rate, the incidence of HIV transmission from parents to child was high at one point of time.
However, such mode of transmission has been significantly decreased with the launching of PPTCT programme in the state.
According to data received from the Manipur AIDS Control Society (MACS), the number of population tested for HIV during 2011-2012 was 48,681 and pregnant women were 46,291. But from March 31, 2020, till date, the number of tests reached 97,761 among the general population and 50,948 pregnant women.
In 2011-2012, the number of people tested positive among the general population was 4.26 per cent (i.e. 20174) of the total population tested and in 2019-2020 was 0.99 (i.e. 973).
For pregnant women, the infection rate was 0.37 per cent (i.e. 173) in 2011-2012. The rate was declined to 0.13 per cent (i.e. 64 cases) in 2019-2020.
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As per NACO, the PPTCT was conceptualised in an attempt to stop HIV transmission from mother to child as it is one of the major routes of infection. NACO stated that in the absence of any intervention, a substantial proportion of children born to women living with HIV get HIV infection from their mothers either during pregnancy, labour/delivery or during breastfeeding.
Without any intervention, the risk of transmission of HIV from infected pregnant women to her children is estimated to be around 20-45 per cent, NACO stated.
Among those HIV-infected parents, 27-year-old Mina from Imphal is one of them. She has been on Antiretroviral Therapy (ART) since about 15 years of age.
Being a mother who got HIV infection from her mother, Mina said she was always concerned about not passing on the virus to any of her children. Despite all care and precaution taken, her first baby girl got infected with HIV and died after three-and-half months. However, transmission of HIV infection was not detected in her second child, a baby boy. This gave her new hope.
“I got HIV infection from my mother and started my ART since class X. My mother pays serious attention in taking care of my health every time. I still remember how she cared about administering me ART at the right time and making her take food supplement. No doubt, following ART helps to control HIV, but as a mother with HIV infection, I don’t want to pass on this virus to my kids,” Mina said.
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She delivered her first child six years ago. But at that time, Mina was unaware about PPTCT programme and was clueless what steps to take to prevent her child from HIV infection. “My baby survived only for three and half months. Doctor told me that she died of pneumonia,” Mina recalled.
Mina, however, came to learn about PPTCT and accessed the programme to ensure that her second child may not suffer any eventuality. She joined routine counselling and health check-up. As an outcome of it, her baby was successfully prevented from HIV transmission.
The problem of ART getting out of stock is one of her main concerns. As it is a life-saving drug for people living with HIV, the state should make a strategy to ensure uninterrupted supply of it and prevent any shortage of this drugs.
“As an HIV infected woman I would like to say that every infected pregnant mother has the responsibility to prevent HIV transmission from mother to child. Willingness to undergo HIV screening and to initiate ART boldly if tested positive are the key to stop passing this virus to your loved ones,” she shared.
Under the PPTCT programme, six-week old babies born by HIV-infected mothers are sent for HIV-DNA-PCR testing. For which, dry blood spot (DBS) samples are collected. If the sample is tested HIV positive, then again the sample is tested for the second time. The HIV-exposed baby will start lifelong ART if it is tested positive in the second test.
But for Manipur, most of the DBS test results came negative as per the MACS report.
Speaking exclusively to the Imphal Free Press, M Sanamatum, who worked as field officer for Imphal West for three years for PPTCT Programme under the AHANA Project, the National Coalition of People Living with HIV in India (NCPI+), said that the role of every parent is very significant in order to prevent HIV transmission to their children irrespective of people living with HIV or not. The primary steps to stop transmission are to undergo HIV screening during pregnancy without fail by every mother.
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The NACO had launched such a comprehensive programme to eliminate HIV transmission from parents to children. But unfortunately some parents are hesitated to access this service not wanting to disclose their status. And some who started the ART therapy unwillingly quit their treatment in between by even leaving their permanent residence just to hide their identity, Sanamatum said.
While working as field officer, a total of 56 pregnant women were guided to access PPTCT. Of the 56 expectant mothers, only one child was infected with HIV, she added.
Sanamatum further said since Manipur is among the states with high HIV infection rate in the country, elimination of HIV transmission to children from parents would not be possible by only waiting for clients by counsellors. It requires lot of survey at the ground level and for this, there is a need to strengthen outreach workers to support HIV-infected pregnant women and their families.
Speaking to the Imphal Free Press, assistant director, monitoring and evaluation, MACS, Paonam Tilotama said that mother to child transmission of HIV was one of the major route of HIV transmission for children in the state at one point of time. However, this trend has been reduced to almost 90 per cent in the state with the implementation of PPTCT programme and Test and Treat Policy for HIV since 2016 under the NACO.
The assistant director said that there are various components under the PPTCT programme. Some of the key services are testing and counselling of HIV to all pregnant women attending ante-natal care with opt out option, provide counselling and initiation of Antiretroviral Therapy (ART) irrespective of CD4 count to all pregnant women, who are confirmed with HIV, provide antiretroviral prophylaxis to infants from birth up to a minimum period of six weeks.
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Integrate follow-up of HIV-exposed infants (HEIs) into routine healthcare services, including immunization, ensure initiation of Co-trimoxazole Prophylactic Therapy (CPT) and Early Infant Diagnosis (EID) using HIV DNA PCR at six weeks of age onwards as per the EID guidelines, Paonam Tilotama added.
Citing the major reasons for the inability to claim zero transmission of HIV from parents to child, Paonam Tilotama said Manipur is still facing the problems of female sex workers and female injecting drugs users that increase the chances of unintended or unplanned pregnancies. Besides this, there might be instances of not accessing ART by HIV-infected pregnant women out of ignorance or fear of disclosing their status and stigmatisation. However, MACS said it is making all-out efforts to provide the therapy to every HIV-infected pregnant woman in the state.
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