South Africa holds a number of unenviable records when it comes to addressing HIV/Aids, but a laboratory opening at the Cape Fertility Clinic signals hope for HIV-positive couples who want to take no chances when it comes to having a healthy baby.
Although the techniques used at this clinic have been helping HIV-positive people around Europe conceive HIV-negative babies for many years, the laboratory is the first of its kind in Africa. Every month about five or six couples with either partner or both infected with HIV indicate a desire to have healthy children.
Although the high costs of the procedures at fertility clinics make it somewhat exclusive, in a country where 92 000 babies contracted HIV in 2007 alone, it shows the medical fraternity’s commitment to offer HIV-positive people an equal chance to have healthy babies signals that HIV-positive people are making informed decisions about parenthood.
The laboratory, by law, is separated from others at the clinic to ensure the risk of passing infection to other clients is contained.
“HIV is no longer seen as a death sentence but a chronic disease,” says Cape Fertility Clinic Director Klaus Wiswedel. “People with chronic diseases are entitled to have fertility treatment. We can safely deliver an HIV-negative child and, with the right treatment, the parent can live a long life.”
How it’s done
The clinic deals with dual HIV-positive couples or where either partner is infected. In cases where both partners, or only the woman is HIV-positive, doctors make use of artificial insemination. Once pregnant, the HIV-positive mother-to-be’s progress is monitored by an HIV specialist. The mom has to continue taking antiretroviral medication, and has to the deliver the child by Caesarean section to reduce the risk of transmission to the infant.
If only the man is HIV-positive, the sperm undergoes a procedure where it is “washed” to separate the seminal fluid which contains most of the cells carrying the virus, from the sperm. The sperm is retested for the presence of any remaining virus and if found to be HIV-negative, the woman can be inseminated.
According to the clinic, the transmission rate is found to be less than one percent if these procedures are precisely adhered to.
UNAIDS estimates that every day about 1 200 children worldwide under the age of 15 become infected with HIV, and at the last count in 2007 there were 2.1-million children living with the disease. The disease is transmitted either before they are born, during labour or during breastfeeding. About 50%of children who contract HIV from their mothers die before their second birthday.
The South African picture
“The prevention of mother-to-child transmission of HIV is not only effective, but also a human right,” said UN Aids Executive Director Dr Peter Piot. “We are seeing good progress in many countries, especially in parts of Africa, but we need to significantly scale up HIV testing and treatment for pregnant women.”
In South Africa, the number of pregnant women receiving drugs which prevents HIV transmission to babies rose from 15% in 2003 to 67% in 2007. Neighbouring Botswana, which has one of the highest HIV/Aids statistics, provided antiretroviral treatment to 95% of HIV-positive pregnant women in 2007.
In January this year the Department of Health unveiled their revised Prevention of Mother to Child Transmission of HIV (PTMTC) introducing stronger doses and more effective medication to HIV-positive mothers. This means that pregnant women enrolled in PMTCT programmes go on AZT treatment (the drug which prevents mother to child transmission) from the last four weeks of pregnancy and during labour. At birth the baby is given a week-long course of AZT and as a further precaution is tested at six weeks.
All pregnant women attending the 1 315 antenatal care clinics across the country are also being offered voluntary counselling and testing (VCT) on their first visit. Those women who test HIV-negative are offered a follow-up test at 34 weeks into their pregnancy. Those who test HIV-positive will be offered a viral load test at the time of their HIV-positive diagnosis to ascertain the level of infection.