MBARARA MEDIA SCIENCE CAFÉ

The Health Journalists Network Uganda (HEJNU) held a media science café in Mbarara City at Holy Innocents Children’s Hospital. The Café was held on 17^th April 2024 under the Topic: “Breast Feeding Practices Among Women Living with HIV: Experiences from Breast Feeding Women Enrolled in Facility-Based Groups at an HIV Clinic”

The engagement started at 8:00 a.m. until 2:45 p.m. and was attended by 25 journalists from different media houses (Attendance List on Last Page).

Speakers

Dr. Mike Kyewalyanga, Pediatrician at Holy Innocents Children’s Hospital:

Catherine Ankunda, A positive living Breastfeeding Mother on care

Fredrick Kamugisha, Health Educator Mbarara District Local Government.

The Café was Facilitated by:

Name Organisation Contact

1: Dr. Mike Kyewalyanga HICH 0783870767

2: Edson Kinene Moderator 0783210324

3: Fredrick Kamugisha Mbarara DLG 0782743312

4: Birungi Jacenta Rapporteur 0786221919

5: Annita Matsika HENJU Convenor 0775865759

The engagement started with a word of prayer led by Isaiah Orimwesiga, a journalist with Grace Radio, and was later followed by an introduction for all participants.

The session was moderated by Edson Kinene

Annita Matsika HENJU convenor for the Western region informed participants that the main purpose of the Café was to equip journalists with enough knowledge and information about the Breast Feeding Practices Among Women Living with HIV

She said the Topic was picked with emphasis on the available policies, research, challenges, and the way forward towards the Elimination of mother-to-child transmission.

Anita asked journalists to ensure that stories about the Café are published for public awareness.

Dr Mike Kyewalyanga Pediatrician at Holy Innocent Children’s Hospital.

Facilitated the current HIV/AIDs research on prevention/interventions among breastfeeding mothers.

What’s being done to prevent and control the spread of HIV among Mothers and their babies?

Dr Kyewalyanga said:

EMTCT and curbing the HIV prevalence as per the most recent statistics stands at 5.4 percent. Highly affected districts include; Kalangala in the first position, then Fort Portal, Mbarara, and Bushenyi districts among others.

Statistics show that Mother-to-child transmission (EMTCT) currently stands at 466 per 100,000 HIV cases which means that for every child who is exposed to 100,000 mothers, 466 will be at risk of HIV transmission and the target as per World Health Organization and UNICEF should be 50 children per 100,000 mothers.

Bringing the vision 95-95-95.

Initially vision was 90-90-90 but towards 2014 it was realized that the target was almost being met, in 2014 same target of 90-90-90 was set for 2020 but 6 years later the target was almost being met, which reason it was extended.

All this was aimed at eliminating HIV transmission/ ending HIV by 2030 and the 95-95-95 stands for by the year 2030 95% of the individuals who are HIV positive must be tested and 95 of these must know that they are HIV positive and are initiated on drugs and 95% of them must have a suppressed viral load

Within the topic of discussion:

HIV transmission among children, those at high risk,

Mothers with High Viral Loads

Mothers not on HAART

Mothers newly initiated on ART

Mothers with very Low CD4 counts <100cells

Mothers in WHO STAGE IV ( CCM/KS)

Babies delivered by Traditional Birth attendants

Infants who never received Syrup Nevirapine at Birth

Babies of Very Low Birth weight

Premature Babies

Different modes of Transmission in Infants;

Antepartum; when a mother is carrying a baby inside the womb, there are very minimal chances that the baby will acquire HIV from the mother because there is NO mixing of blood.

While Intrapartum there is a greater percentage of transmission during birth the exposure to maternal blood by the baby and also the procedures that will followed during delivery.

There are other risky procedures that we do in the hospital, for example, failure to use protective gear, gloves, and unsterilized equipment so we can transmit this virus to the baby.

However, about 5 percent of child transmissions are through breast milk from the mother to the infant; that’s a great percentage that needs to be eliminated.

Benefits of Breastfeeding

World Health Organization (WHO) and UNICEF recommend that if the baby is born to an HIV-positive mother, the baby should be breastfed exclusively for 6 months except for drugs and after 6 months the baby continues with other feeds introduced in up to one year and at one-year breastfeeding should be stopped.

Benefits of breast milk are to prevent malnutrition and other advantages of breast milk so instead of the risk of transmission you rather concentrate on other feeds but minimize breastfeeding.

At whatever point a pregnant mother is encountered treatment must be initiated, and at whatever point an HIV-positive mother and breastfeeding is encountered treatment must be initiated.

As the baby is growing the HIV risk is reduced because of the baby’s growing immunity, however, the risk still exists, and the need to minimize breastfeeding because the benefits of breast milk have reduced after one year so better to stop breastfeeding and minimizing the risk of transmission than keeping the baby on the breast with minimal benefits at that age.

There are situations where a mother is not breastfeeding, with some reasons the mother refuses to breastfeed because of her HIV status, in such a situation preliminary tests are done depending on the age of the child, then wait to do a test 6 weeks after the period of breastfeeding.

Other Transmission Modes

Traditional practices, false teeth extraction by traditional healers, using unsterilized gadgets so there is transmission of germs like hepatitis and HIV from the equipment they use, exposing the baby.

A child testing positive while both parents are negative, recommending testing the housemaids and other members of the house

“Never take housemaids to be the most disadvantaged in a home, you can never know their HIV status and behavior always test them”.

EXTRAS for HIV MYTHS:

A lot of Christians claim to have cured HIV through their faith. Such myths should not be accepted in communities as they can negatively impact the fight against the virus.

He warned that HIV can never heal by prayer and must come out clearly whether you’re praying by a certain mission, or with the Pope, HIV and science don’t mix.

The need to be more careful with most of the followers that come to give testimonies in churches, not all churches are credible some of those people are simulated patients, who are told what to do, and others present to fake results.

People present undetectable results as negative when the virus is suppressed, as a result of proper ARV medication.

Warned that undetectable viral load does not mean one is cured of HIV.

Recommendation on sexual behavior is, don’t find partners If you believe that testing them and finding them HIV negative then that is the right sexual partner for you, You will fall into a trap, why get engaged in sexual behavior when you know there is a risk”?

Most people have suppressed their viral load, advising people to always test from the hospitals and not self-testing.

Fredrick Kamugisha-Health educator Mbarara district:

Response of breastfeeding mothers towards HIV/AIDS prevention/interventions in Mbarara district.

The elimination of mother-to-child transmission starts with the mother during antenatal care.

Kamugisha said the roadmap from SEX to DELIVERY is what will safeguard/protect the child from HIV transmission.

Mothers need and must understand the importance of breastfeeding you can never talk about breastfeeding after delivery, the mother during antenatal care is taken through the importance of breastfeeding and the challenges she is likely to meet when breastfeeding.

HIV tests are done during antenatal and when a mother tests HIV positive she is initiated immediately on the drug to reduce her viral load to prevent mother-to-child transmission.

“If the mother comes for antenatal late, is examined and found Positive, the drug will be initiated to her late there are more chances that this mother will give birth when the viral load is not suppressed and that will put the child at risk even during breastfeeding”

The World Health Organization recommends that HIV-positive mothers avoid breastfeeding, only if other affordable and feasible alternatives can be used to feed the child.

In Africa, Uganda in particular the socioeconomic status of mothers, other alternative methods may not be possible so in that regard, recommend breastfeeding exclusively because of the importance of the milk.

“Because it’s exclusively breastfeeding, if the mother is not taking her drugs properly the viral load will be high and the virus will exist in the milk, so you have to make sure that you educate the mother to understand that taking drugs consistently will help a child not to acquire HIV”.

The duration of breastfeeding matters, if the child has had prolonged interaction with the mother on the breast for some time the mother will have to stop breastfeeding her to prevent HIV transmission.

“We encourage safe based breastfeeding practices before 6 months and alternative feeding after 6 months to prevent the child from becoming malnourished and being exposed to infections from a positive mother”

Mothers who afford alternative best feeding methods to use, for example, infant formula, also known as formula milk, can feed their children on that rather than pre-exposing them to the breasts.

“But remember breast milk is more nutritious it has those unique antibodies, but it doesn’t stop the baby from acquiring HIV from a positive mother, however, there is a system in place for early infant diagnosis, to easily detect that the child is either positive or negative for protection”.

The Ministry of Health Intervention of Mother to Child Transmission (EMCT) earlier it used to be between 25-40% percent transmissions but since the introduction of the program, the HIV rate in breastfeeding mothers has gone as low as 5% and with non-breastfeeding as low as 2%. This has saved many lives of infants from acquiring HIV.

Challenges

Africans amidst cultural norms removing a child from the breast at six months will spark quarrels with the mother-in-law, African mothers breastfeed their children for two years, not 6 months thus sparking domestic violence in the family.

Associated challenges such as emotional stress and the need for counseling services.

Solutions to Challenges

Multi-Sectoral Support

“When we are dealing with challenges affecting the mothers who are breastfeeding it requires not only care and treatment but we need a multi-sectorial approach/multiple key players to support these mothers so that they go through the journey of knowing their children despite any result.

Recommend support systems for HIV-positive guidance, which support systems are not found in the health centers, but in homes and the community.

“We encourage community support groups that come together to share information about breastfeeding and what the positive HIV mothers can do to prevent their children from acquiring HIV”

Men should be involved in supporting mothers not only during antenatal care but also after birth, which gives relief to the positive mothers.

Working with key populations and organizations to curb HIV transmission.

Introduction of the condom distribution program, especially in Rutooma-Bwizibwera Town Council and Rubindi Sub County.

HIV prevalence in Mbarara district.

Stands at 4.1% with the incidence rate at 3 per 1000. And the total HIV population is 7000 people.

Experts Call In The Fight

Institutional deliveries to achieve the 95% 95% 95% target by 2030 HIV suppression in pregnant mothers.

Ankunda Catherine:

Experiences of Breastfeeding while Living a positive life. Tested in 2018 and found herself positive, “it was not easy for me to start on treatment but I was counseled, cooled down and prepared myself to start medication/treatment it was not easy to start that medication”.

“the day I will never forget is the day I took my first tablet it was on Valentines’ Day”

Took me time to inform my mother/relatives about my status, it was hard to tell but made up my mind and told them in 2022, with all that positive life stigma

Ankunda got a husband two years later she openly told him the truth about her HIV status, by her looks, jokingly the man never took it seriously later they went for testing, and Ankunda’s results returned positive and the Man Negative.

To Ankundas’s surprise, the man proposed for marriage and insisted, they went for introduction rituals (Kwanjura), and have since lived a discordancy relationship.

“We have lived a discordancy life, we have produced our child who is negative and we are happily married and my husband is very supportive”

Ankunda said “My husband is supportive, reminds, and encourages me to take my medicine even when am traveling or when busy, I have suppressed my virus. So I encourage HIV patients never to miss on their medication so that they can suppress the virus in the bodies”.

She said “My child tested Negative and I have committed to keeping it that way by administering her drug timely and rightly”.

CHALLENGE

The biggest challenge is administering the drug to babies, since it is in tablet form it becomes hard for the baby to swallow, and sometimes she vomits making the dosage half.

“I plead with the health experts and researchers and government to come up with a drug that can be administered through injection”

RECOMMENDATION

The government to provide HIV health services in all health facilities and always keep the messages in the media to remind the population that HIV still exists and Kills.

According to Ankunda, the government has played a big role in preventing mother-to-child HIV transmission.

“if you go to the hospital or any Health facility they test you during antenatal and enroll you in counseling sessions and how you should live. It is then up to you as a parent to practice whatever they tell you to protect your child from HIV transmission”

“So I advise HIV-positive mothers to follow the medics’ prescription so that we can always produce healthy children”

The responsibility remains with the parent to ensure their child born negative remains un-infected.

Encouraged HIV Positive living persons to open up to their partner for their protection.

“it becomes hard to speak because when you tell your pattern, you either married while positive and you didn’t tell him/her, and when they get to know domestic violence starts but if you reveal/tell the truth and the health officers counsel you your relationship goes on well”.

ATTENDANCE LIST

NUMBER NAME MEDIA HOUSE

1 AKAMPA GILBERT PARROTS MEDIA

2 ASHABA EDITH UGANDA RADIO NETWORK

3 AKATUKUNDA NELSON UBC TV

4 ONESMUS NUWAGABA UBC RADIO

5 AGGERY TWESIGYE CROOZE FM

6 CRYSTAL ELIZABETH LIT TV

7 JULIUS BYAMUKAMA NTV

8 ALEX MUGASHA NBS TV

9 AMOS TAYEBWA RED PEPPER

10 MARTIN NEBYE SKY TV

11 PEACE ASIIMWE REVIVAL RADIO

12 KYIRU RAMATHAN BUKEDDE TV

13 TUSHABE ANDREW TV WEST

14 JOVITA KYARISIMA NMG

15 ISAIAH ORIMWESIGA GRACE RADIO

16 ALINDA BAGENDA GRACE RADIO WEST

17 ELLY NYESIGA ENDIGYITO RADIO

18 MICAH KAMUSIIME THE INFORMER

19 ELIAS NUWAMANYA ANKOLE TIMES

20 BETH AKATUKUNDA SOCIAL MEDIA

21 JOSHUA NAHAMYA COOPERATOR NEWS

22 SANDRAH KEITESI ENDYITO FM SOCIAL MEDIA

23 COSLYN NAKAYIRA DAILY MONITOR

24 ADELLAH ORISHABA SKY TV

25 DERRICK KATUSIIME LIT FM

Developed Stories after the engagement

Parents Warned against Housemaids- Health experts have cautioned mothers who leave their children under the full care of Housemaids they risk acquiring HIV.

Ugandans urged to Test for HIV- People refusing or failing to test for HIV has hindered the fight against HIV in the country

https://x.com/radiowestug/status/1780528428455792697

https://x.com/radiowestug/status/1780510063544639991

https://x.com/radiowestug/status/1780506874460131391

https://x.com/radiowestug/status/1780506943582355496

https://x.com/tush_andre/status/1780619156368331183

https://x.com/KweziNinye/status/1780621329814724694

https://x.com/KweziNinye/status/1780547531937595630

https://x.com/ellykaranzi/status/1780492568733552799

https://x.com/edson_kinene/status/1780615371906572667

https://x.com/edson_kinene/status/1780608842868363631

https://thecooperator.news/hiv-journalists-urged-to-support-pmtct-campaign/