Catching Up With a Friend

Yesterday I was blessed with a surprise visit from my friend Rose. Although we had traded text messages, I hadn't had a chance to meet up with her and get caught up on news. And, believe me, she had a fair amount of news. I first met Rose at the Webuye AMPATH Clinic where I go for my checkups while here in Kenya. She was working there as a peer counselor when I first went in for my initial vist a year and a half ago. She's someone that I've come to respect for many reasons, but the main one being that she is open about her status as an HIV Positive woman here in Kenya. That's not a common trait.

But first, let's talk a little bit about what AMPATH is. The following is taken from their website.
"The Academic Model Providing Access to Healthcare (AMPATH) is Kenya's most comprehensive initiative to combat HIV. AMPATH is a working model of urban and rural HIV preventive and treatment services in the public sector. AMPATH cares for more than 55,000 HIV infected adults and children, with nearly one-half of all patients on anti-retroviral drugs, and enrollment into the program rising by 2,000 patients per month.

A robust program to prevent mother to child transmission of HIV has been initiated including an opt-out testing policy and programs fostering triple anti-retroviral therapy of pregnant woman and formula feeding of newborns. AMPATH has implemented programs that foster food and economic security for HIV infected persons and their families. AMPATH demonstrates the power of US and African academic medical centers united by common vision. (http://www.medicine.iupui.edu/kenya/hiv.aids.html)"

It's a partnership between the Indiana University School of Medicine and the Moi University School of Medicine here in Eldoret Kenya. There are 19 locations throughout Western Kenya. I visit the Webuye location which is about 30 minutes away by matatu. Although I only go for lab work and medication refills, the clinic does much more than that for Kenyans living with HIV. They help to insure that patients are receiving enough food to maintain their health and provide it when necessary. In addition, they do a lot in the way of Mother-To-Child-Transmission Education, family counseling and so forth.

I think what first struck me when I met Rose was the fact that she did not appear outwardly shocked to learn that an 'mzungu' was in the clinic receiving care for HIV. Trust me, I'm a surprise to many people here. It is not something that is really considered. I'm the anomaly when I walk into a large, crowded waiting room full of black faces. My pale skin is in stark contrast. I like to think that it helps to show that HIV/AIDS is a disease of the world and not the burden of just one country.

But, let's get back to Rose and what she does. She is a peer outreach worker for the clinic. Part of her job is to follow up with patients that don't come in for their regular checkups. She calls or visits them to see what issues and problems they are encountering. Did they simply forget or are they 'falling out of care." But, Rose is also active as a volunteer within the positive community. She helps to lead a youth support and discussion group to help reduce the spread of HIV. It is a group that is open to all youth regardless of their HIV status. They hold meetings to discuss prevention, have testing days, promote safer sex, and have support meetings for those infected. She is no different than the many activists I know back in the US.

When I left Kenya in October 2008, Rose was several months pregnant with her fourth child. This was her first child conceived as an HIV Positive woman. My parting visit with her was at the Webuye District Hospital where she had been put on bed rest. She was hopefully that she would be able to carry to term as was I. The great news is that she is now the mother to a healthy four month old boy named Joseph. This is the first son. To date, he has continued to test HIV negative.

So, with that being said, it's on to the primer about Positive mothers giving birth to babies. I have thought about it and won't go into a huge educational lecture on MTCT. If you want to learn a lot, just do a Google search. However, many babies are not born HIV+. Other babies are born and test positive only because they are still carrying the antibodies (which is what the tests look for) of the mother. Rose's son was born and tested negative. He went on a short dose of antiretrovirals immediately after birth to help protect him. There is still a risk of transmission through breastfeeding, but breast feeding is the best option for babies here in Africa. This is because the mother's milk helps to provide some natural immunity to the diseases natural to the area. In addition, a baby is more likely to die from malnutrition than become positive. Also, parents can not afford formula and have difficulty insuring that there is sanitary water and bottles. And, finally, there is still a huge stigma for not breastfeeding a child here. So, the recommendation is that a mother exclusively breastfeed for 6 months and then begin to wean as food is introduced.

So, where does Joseph stand now (or lay, since a 4 month old doesn't walk). He continues to test negative. He'll have another test at 6 months, then 1 year, and a final one at 18 months. But, all things right now look very promising that he'll remain HIV negative.