Motherhood Vs HIV Positive Women

Motherhood Vs HIV Positive Women
On Mohan Singh and Savitri Devi’s list of must dos is to be around when their grandchildren get married. Sheela Chakravarty does not want another child while after the passing away of his wife, Salimuddin Khan plays both mother and father to his son, seven. In Saima Khatoon’s (23) case the responsibility of being both parents to her four year old son has fallen on her. Singh, Devi, Chakaravarty, Khan’s son and Khatoon are HIV positive.

Puja Awasthi
August 21, 2010

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The debate on whether or not motherhood is for HIV infected women and how to respond to mother to child transmission has raged for almost two decades. In their own little corners of the world, people are responding to the challenge differently.

Thus while Singh (34) and Devi (27) look forward to becoming grandparents and treat their condition as “manageable”, Chakravarty (23) says she would never have had a child had she known her status.

Despite being associated with the district level network (DLN) of positive people (a body that at its regional apex has a state network and a national network at the country level) and being regularly counseled, doubts still circle in Chakravarty’s mind on the status of life. “I felt the earth beneath my feet give way when I learnt about
my condition”, she says.

This revelation came in the seventh month of her pregnancy; too late to consider a termination. There was a brief period of resentment towards her husband who had been a taxi driver in Mumbai for some years but her doubts also pointed to possible infection from hospital instruments that had been used at a private hospital where she had been operated for an intestinal problem three years after her now nine year old marriage. For now however her unrelenting focus is on her nine month old son Moni, whose status Chakravarty will not know for another nine months.

Though there have been advances in medical science to reduce the chances of mother to child transmission (MTCT) according to an UNAIDS paper in developing countries the focus is on “provision of single-dose intrapartum and neonatal nevirapine, which cuts the risk of HIV transmission by more than 40 per cent." The paper advocates a combination of drugs to cut risks of transmission and further notes: “development of affordable regimens with superior resistance profiles is an urgent global priority”

Figures put out in 2009 by the National AIDS Control Organisation (NACO), the highest body for implementation of HIV-AIDS related programs in India, say that the chances of MTCT are 5-10 per cent, even in cases where the mother has her delivery in a hospital and the child is given the necessary medicines. During normal labour and delivery these chances increase to 10-15 per cent, while breast-feeding gets these figures to jump to 20-25 per cent.

When examined under the lens eye of these figures, Khatoon appears singularly lucky. When she came to know of her positive status, she thought of it as “just another disease” and went on to breast feed her child for almost a year. Her son is now four and negative. Her husband Afzal died a year ago, aged 28. He was a skilled zardozi embroidery artisan and had worked in Mumbai and Goa for a number of years before getting back to his family in Lucknow.

Khatoon declares she is healthy and capable of looking after her son. She has also taken it upon herself to educate adolescent girls in her rather conservative old Lucknow locality on responsible sexual behavior. “They know my status and can speak to me freely”, she says.

For 36 year old Salimuddin Khan the news that his wife was HIV positive “shook the ground beneath his feet” as he says. She died two years ago, leaving behind a seven year old son who is positive and a five year old daughter who is negative. Khan himself is positive. He works as an auto rickshaw driver and has adjusted his work timings
such that he can be home when the children get back from school. Playing both parents is not easy he admits but help is at hand in the form of his sister in law who, he says, is like a mother to the two children.

Dr Suman Shukla, the Medical Officer at Lucknow’s Chattrapati Shhauji Maharaj Medical University ART centre says, “We do not advocate termination of pregnancy as that carries its own risks. The administration of ART (Anti Retroviral Therapy) drugs is stopped in the first trimester to avoid any harm to the fetus. Although it is much better that positive mothers do not have babies because of the
larger social and medical implications and we do advocate adoption, we cannot take away a woman’s right to motherhood. In my opinion however one child is enough and I discourage such women for going in for a
second pregnancy.”

Dr Rekha Sachan is of the same opinion. “To perpetuate one’s family is a human right, which we cannot snatch away. In fact if a positive woman asks me if she should go in for a pregnancy I do advice her to increase her CD4 count (the measure of how well the immune system of a person is functioning) and then think of conception. One precaution we do take is to go in for planned caesarians as fetal death rate in normal deliveries is high. That way there is minimal risk to the mother and child and also the chances of infection to the attending staff in the operating room are minimized.”

Though she points out that children born of positive mothers have compromised growth and the mothers are prone to anemia and gastroenteritis, she says that with proper follow up these conditions can be taken care of.

“I am not afraid of dying, for that is inevitable”, says Khatoon. “Instead if thinking of my status and dying bit by bit every day, I would rather concentrate on building a future for my son.”

It is a sentiment that probably anchors most HIV positive parents.