Saturday, November 9, 2013

Prevention of Vertical Transmission of HIV: A Community Approach


Due to the high prevalence of HIV in the Mufindi district of Tanzania, any HIV preventative measure, such as prevention of vertical transmission through breast milk, is vitally important to the overall health of the community. Local health facilities, and any stakeholders in the health sector, need to consolidate their message on HIV treatment so as to deliver a clear and understandable method of preventing the spread of the disease. Advice to HIV positive mothers on breast-feeding practices has been historically confusing, so added interventions to clarify the message are paramount (Africa: HIV-Positive Women Still Confused About Infant-Feeding Choices, n.d.).  One of the more powerful ways to bring unity to this message is through community involvement, which can have tangible benefits such as lowering the incidence of new infections (Celentano et. al., 2008). A community approach to spreading the message to as many mothers affected by HIV as possible would be most effective in bringing education to all, and adding more than just treatment to the fight against HIV (Lancet, 2001).
By engaging with community members that might not be fully trained health professionals, but are nonetheless seen as leaders in the health sector, the message could be spread most effectively to each HIV positive mother in the community at the grassroots level, as this is a proven method for sharing information in a rural setting (Anafi et. al., 2012). To parlay the message of HIV prevention options to each potential mother affected by HIV in the area, various stakeholders from the community need to be sharing the same message to all of their clients and neighbors. This will ensure a unified message that will make it easier for these women to understand and properly educate themselves.
In order to get the community involved, steps must be taken first to clarify exactly what the problem is, then how it can be solved. An HIV+ breast-feeding mother from this rural area can be easily confused or convinced not to do the right thing if there are mixed messages.  Various community leaders need to be informed together about how the community in Mufindi can better prevent vertical transmission of HIV through breastfeeding in order to avoid mixed messages and to guarantee the correct message is hitting the mark.  One method that could be used is a study circle, in which private meetings can be held with all stakeholders to identify the problem of vertical transmission through breast-feeding, to clarify the options available and initiate a plan on how to educate the public about the solutions.
In this particular instance, the stakeholders comprising the study circle are of upmost importance, as without them, the plan to involve the community would not be able to reach its full potential.  Religious leaders should be involved as their faith based communities listen to them for moral guidance (Trinitapoli 2006). In the majority of villages in Mufindi, there is no access to a clinical officer let alone a doctor, so community members are forced to go to traditional healers and local midwives, called wakunga, who assist community members daily. They should be on the forefront of current health knowledge, as often people seek out their wisdom, and in some cases, trust them more than they trust a doctor of Western medicine (Marlink, et. al., 2009).  Brining these healers up-to-date and on the same side will be the best line of defense the community has to getting the message out quickly and effectively.  Alongside the local healers and wakunga, health care workers, community members that have received a basic training in young children’s health, should also be invited to participate in the study circle.  They meet the mothers in the community every month to educate on nutrition and good health practices, weigh babies and monitor their development, give vaccinations for those in need, and advise mothers on various topics from birth control to teething.  As all mothers in the community are familiar with these health workers already and a trusting relationship has already been established, they are perfect candidates to speak to the public and educate en masse proper breastfeeding practices for HIV positive mothers.  Finally, Home Based Care Volunteers (HBCV) could help spread the word of up-to-date breastfeeding protocols to help in lowering the incidence of HIV in breastfeeding children as they have already made a network of patients in the community and are looked at as reliable, trustworthy advocates for the community members’ health (Ford, et. al., 2013). 
At the study circle, members would be invited to discuss the topic of HIV-positive women breastfeeding and everyone would be educated with a clear and concise solution. Change would then take place after the study circle as the community members would be hearing the same message from all respected leaders of the community: at the health clinic with the doctor practicing western medicine, with the local healer practicing local medicine, when the mkunga helps deliver a baby, when a mother goes to a ‘weigh day’ in the village and finally when the HBCV comes to visit.  Everyone is saying the same thing.  If a community member didn’t trust the first person, but kept hearing the same message from four or five other wise and trusted members of the community, the likelihood they would listen, and therefore react, would increase. 
By getting the key community leaders involved in sharing the message of health education, HIV positive breast-feeding mothers are more likely to hear the message and more likely to follow through with the appropriate intervention. As HIV can be transmitted through breast-milk, it is of extreme importance to ensure HIV positive mothers know exactly how to prevent this vertical transmission.  One strong and consolidated message needs to be heard from all sources surrounding them. Community involvement in HIV prevention is constantly evolving (Heise, et.al. 2013) and engaging the community on this HIV prevention intervention is a leading method for change in this area.


References
1. Africa: HIV-Positive Women Still Confused About Infant-Feeding Choices. (n.d.). Retrieved October 19, 2013 from: Integrated Regional Information Networks website: http://www.irinnews.org/report/94432/africa-hiv-positive-women-still-confused-about-infant-feeding-choices

2. Anafi, P., Asiamah E., Agyepong I., Oduro G.,Y & Owusu-Danso, T. (2012). Using Appropriate Communication Strategies for HIV Prevention Education in Rural Communities in Ghana. Princeton Papers – 120613.

3. Celentano, D., Charlebois, E., Chingono, A., Coates, T., Fritz, K., Khumalo-Sakutukwa, G., Modiba, P., Morin, S., Mrumbi, K., Singh, B., Sweat, M., Van Rooyen, H., Visrutaratna, S., (2008). A Community-Based Intervention to Reduce HIV Incidence in Populations at Risk fro HIV in Sub-Saharan Africa and Thailand. US National Library of Medicine National Institue of Health. Vol. 49(4). pg. 422-31.

4. Community Based Approaches to HIV Treatment in Resource-poor Settings. (2001). The Lancet. Vol. 358. August 4, 2001.

5. Ford, N., Frost, P., Mburu, G., Mwai, G., (2013). Role and Outcomes of Community Health Workers in HIV care is Sub-Saharan Africa: A Systematic Review. Journal of the International AIDS Society 2013. Vol. 16.

6. Heise, L., Slevin, K., Ukpong, M., (2013). Community Engagement in HIV Prevention Trials: Evolution of the Field and Opportunities for Growth. Publications from Path.org AIDS2031.

7. Marlink RG, Teitelman ST, eds. From the Ground Up: Building Comprehensive HIV/AIDS Care Programs in Resource-Limited Settings. Washington, DC: Elizabeth Glaser Pediatric AIDS Foundation; 2009. http://ftguonline.org.

8. Tools, Trends, and New Technologies in HIV Prevention. Retrieved from October 19, 2013 from Interagency Coalition on AIDS and Development website: http://www.icad-cisd.com/pdf/Tools_trends_and_new_technologies_in_HIV_prevention_EN.pdf

9. Trinitapoli, J., (2006).  Religious Reponses to AIDS in Sub-Saharan Africa: An Examination of Religious Congregations in Rural Malawi. Review of Religious Research 2006. Vol 47:3. pg 253-270.

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