Preventing Mother to Child Transmission of HIV in Mwandi, Zambia- A Success

Welcome to this installment of the AIDS Pandemic, a podcast hosted by Dave Wessner of the Department of Biology at Davidson College. I am Sarah Bertram.

This past summer, I traveled to Mwandi, Zambia through a Davidson biology and pre-medical program. Mwandi is a predominantly Lozi village of about 7,000 people and the catchment area totals about 25,000 people. We spent 5 weeks in Africa, 3 of which were spent working in the Mwandi Mission Hospital, the Mwandi AIDS clinic, the Orphans and Vulnerable Children’s center, and the Mother and Child Health Center. We all went with a research topic to study that was based on some aspect of Mwandian life. I looked at Mwandi’s Prevention of Mother to Child Transmission of HIV, otherwise known as the PMTCT program, and its effectiveness over the past three years. Here, I will talk about my findings.

About out of every five pregnant women in Zambia is infected with HIV and without any prevention or treatment interventions, more than 300,000 babies would contract HIV from their mothers each year. Starting in 1999, many Zambian mission and government hospitals started PMTCT programs. The Mwandi PMTCT program was launched in 2005 by an American Pediatrician in conjunction with the Mwandi missionary who was going to serve as the leader of the program. The procedure for PMTCT at the Mwandi Mission Hospital is as follows: 1) discuss the PMTCT program and HIV/AIDS information during group antenatal care visits, 2) offer private pre-test counseling, 3) test the mother for HIV and CD4 counts and give her the results, and 4) offer post-test counseling and discuss further treatment and a re-test in three months. According to the hospital staff in Mwandi, HIV testing of any pregnant mother is required by law in Zambia.

If a woman tests positive, she is evaluated at the Pastoral Care Center for AIDS treatment. If she is considered a WHO stage IV or has multiple symptoms for WHO stage III, HAART treatment is usually started unless the woman chooses to undergo short-course treatment instead. Many of the HIV positive mothers choose to undergo HAART treatment because of its documented increased ability to treat HIV/AIDS symptoms and to lower the viral load by decreasing viral replication. The Mwandi hospital staff is good about giving options to the positive mothers and explaining each option and its risks and benefits. Due to the staff’s willingness to counsel and inform the HIV positive pregnant mothers of treatment options, a majority of these women decide to take part in a course of HIV/AIDS treatment in order to help themselves and to prevent the transmission of HIV to their babies.

Although record-keeping is sparse and sometimes hard to find and evaluate, some records for the PMTCT program proved helpful in evaluating the program’s success over the years. From March of 2005 to September of 2007 (before HIV testing was mandatory), 1,205 women attended an antenatal care appointment to sign up for the PMTCT program and of these 1,205 women, only 35 women or about 3% refused the HIV test. Of the 1,170 women who agreed to be tested, 24.4% tested positive for HIV. This statistic is quite high, but reflects the belief that about 1/3 to ¼ of Mwandi’s population is infected with HIV. Because the PMTCT program was in place, the HIV positive women were able to learn their status, get treatment, and prevent (for the most part) the transmission of HIV to their babies during pregnancy, delivery, and breastfeeding.

Mwandi’s PMTCT program has changed drug regimens in order to stay current with the most effective treatments. Originally, the program was based on a single dose of nevirapine given to the mother during delivery and to the baby right after birth. In April of 2006, the PMTCT program switched to a dual therapy involving both nevirapine and AZT for both mothers and babies. Starting in November of 2007, Mwandi updated its treatment regimen to the most current and effective triple therapy drug treatment. This drug therapy involves a mixture of AZT, 3TC, and NVP for the mother and baby. This new therapy has proven to be very effective and the PMTCT program workers approximate that transmission from mother-to-child rates have decreased to less than 10% and possibly even as low as 6% or 7%.

Possibly the most enticing aspect of the PMTCT program for pregnant women is the free formula feeding program provided to HIV-negative babies of HIV-positive mothers. Breastfeeding is the most common type of mother-to-child HIV transmission, so by providing free formula for those babies who test negative (after 6 weeks of age), the worry of transmission by breastfeeding can be alleviated. Currently there are over 100 babies receiving infant formula and most, but not all, are HIV-negative babies of HIV-positive mothers who participated in the PMTCT program. The program has never resulted in a case of child dysentery, a common negative outcome of formula feeding programs, which is often a result of incorrectly boiled water used to make the formula. This clean record is a result of the care and attention put forth into teaching the mothers how to correctly make the formula and clean the bottles.

Compared to many other Sub-Saharan African PMTCT programs, Mwandi’s program is doing a very good job of keeping the program advancing, as far as the number of women being treated and the updates to newer forms of drug therapies. The program could however still make larger strides in incorporating more women from far out in the catchment area and by possibly providing more rural village outreaches for the sole purpose of PMTCT.

Social Components of HIV/AIDS Transmission in Mwandi, Zambia

I'm Dominique Maietta.

Mwandi is a relatively rural village in the South-Western corner of Zambia. The town is home to the Mwandi Christian Hospital, which has a catchment area of approximately 25,000 individuals. During the summer of 2006, I traveled to Mwandi in order to study the psychological and social components associated with HIV/AIDS there. Here I will talk about some of my findings.

The incidence of HIV in the village is around 30-40% and the percentage of HIV positive people is larger within the Mission Hospital patient population according to interviews with medical officers on the hospital staff. The majority of the interviewees expressed their feelings that economic hardship is a major social component of the spread of HIV in Mwandi, just as it is in the rest of Sub-Saharan Africa. Despite the influx of education and knowledge regarding HIV and it’s spread, including mandatory classes in the schools and public service campaigns around the country, the low financial status of the Mwandi community is the root cause for many of the risky behaviors associated with HIV transmission, such as multiple partners and non-use of condoms. This need to engage in risky behaviors appeared to be a particular problem for women and girls who have no other way of making an income other than through sex. Sex for them is not about emotion, but instead about survival.

The problem of poverty affecting HIV rates in Mwandi has further been exacerbated by the construction of a new paved road linking this relatively rural village to other towns and countries. The relatively recent accessibility of Mwandi to the outside world has introduced truckers and migrant workers as passer-bys to the village, and thus created a uniquely new set of problems for HIV transmission in Mwandi. These migrant individuals provide both a source of income for the impoverished village, but also a ready supply of HIV positive individuals to transmit the disease to villagers. As one social worker explained to me, when people come, they come looking for women. Thus the presence of the road, and the truckers from neighboring countries provide a source of income for destitute women and girls with no other means of providing income for their families. Interestingly, the use of sex for money in Mwandi is not so much acceptable, but merely a behavior that occurs, and according to one nurse I spoke with, “this is one of the poorer parts of Zambia, and if a woman has to keep her family, especially if her husband is not around, she will do it somehow”.



Gender disparity issues, then, apart from womanizing on the part of men, is also seen as a major social component of HIV transmission in Mwandi. While men have the power and social standing to hold jobs and make money, women and children have no similar means of providing for their families. Furthermore, although some male orphaned heads of household are given governmental support such as fishing nets which can be used to make a living, young females in similar situations are given minimal support. Thus when husbands die or children are left orphans due to the death of their parents, (generally as a result of AIDS), there is little those children or women can do to raise money other than to fall back to prostitution.

The lack of finances for much of the Mwandi community was also linked by many of the people I spoke with to excessive alcohol consumption, which contributes to promiscuous sexual behavior among Mwandi townspeople. A majority of village leaders perceived that the paucity of jobs and alternative activities in Mwandi village led to the abuse of alcohol followed by unscrupulous sexual activity, (especially by men), which in turn exacerbated the already present problem of HIV transmission. The custom of casual sex and multiple partners was prevalent among men before the HIV pandemic, and is viewed in Mwandi as the “normal mode of boy existence”. This acceptance of male promiscuity also appears to be a key contributor to the continuance of HIV transmission in Mwandi. Lack of sexual control exerted by women, (especially wives), combined with a lax view of expected fidelity in men has resulted in a growth of HIV transmission as husbands will sleep with several partners, become infected, and then infect their wives.

Although it was generally recognized that women lacked the social dominance and power necessary to prevent their husbands from suffering the results of their risky behavior, there were conflicting views as to whose behavior was “responsible” for the spread of HIV. Many of the male interviewees implicated the social behaviors of young people and prostitutes in the spread of HIV. In Mwandi many traditional family cultural values are being challenged with the introduction of the “modern life. As a result, many perceive that young people and their rampant and unprotected sexual behavior is a major social problem contributing to the spread of HIV. This behavior is most often the result of children behaving in a manner mimicking their adult counterparts.

Thus, in Mwandi, extreme poverty combined with alcohol abuse, accessibility to outsiders, and a lack of role models attempting to change behavior are the main factors contributing to the spread of HIV. As the village and the rest of the world becomes more aware of these social factors, changes can be gradually made to stop those underlying social behaviors that support transmission of HIV. Already in Mwandi village leaders have begun to address the issues of poverty and gender disparity by supporting religious and governmental run support groups and clubs to promote sustainable income by women there. Furthermore, use of traditional drama has been incorporated in order to increase public knowledge about the connection between underlying social factors and the spread of HIV in order to stop the cycle of transmission. Although there is much work to be done, the residents of Mwandi are moving in the right direction to combat the social facets contributing to HIV transmission in Mwandi.