Breaking the cycle(2)

Although PMTCT therapy is free in China, many HIV-positive pregnant women forego treatment out of ignorance or fear of discrimination. Photo: Li Hao/GT

"The doctor simply said that through PMTCT therapy, it would be more likely for me to be able to give birth to a healthy child, without further explaining."

Li Nannan, a 20-year-old HIV-positive woman from Henan, gave birth to a boy in February.

She met her husband, who is not HIV-positive, online after dropping out of high school, and they were married one year ago.

Although she and her husband knew that she was HIV-positive before trying for a child, Li did not begin taking antiretroviral medication until three months into her pregnancy, due to a complete lack of knowledge about the existence of PMTCT.

"We didn't think much about whether our child would have AIDS or not," said Li.

Li only discovered that there were measures she could take to prevent the likelihood of transmitting HIV to her child when she went to the hospital for her three-month check-up.

"Before that I never heard about PMTCT," confessed Li.

Since giving birth, Li has had to continue taking antiretroviral medication, in order to prevent mother-to-child transmission of HIV.

Li's son is now 10 months old, and the two health check-ups he has undergone so far have shown the boy to be strong and healthy.

"We can't be sure until he's 18 months old that he definitely doesn't have AIDS. But the check-ups we've had give me faith that he will be ok," Li said.

Zhang said PMTCT would ideally start from the beginning of a woman's pregnancy, all the way through labor, delivery, and the mother's lactation period.

Economic struggles

Given that many HIV-positive mothers in China fit a similar profile to Sun and Li in coming from impoverished rural backgrounds, financial concerns are a common worry.

Due to their poor health, no one in Sun's family has a full-time job. They survive through part-time labor and personal government subsidies of about 100 yuan ($16.27) per month.

"The thing that I need most now is to find a job so I can earn money to raise my child," said Sun.

As part of Sun's post-birth PMTCT treatment, she has been advised not to breastfeed, and given drugs to suppress the secretion of breast milk.

Although the medical costs of antiretroviral treatment are covered by the government, Sun worries that she will not be able to afford the cost of milk powder.

One of the organizations in China that has been set up to give financial aid to HIV-positive mothers facing economic hardship is the Chi Heng Foundation.

In addition to their goal of generally raising awareness about HIV/AIDS, the foundation provides financial assistance to individuals and families for medical costs, tuition fees, and general cost of living.

The foundation began giving aid to HIV-positive mothers and their children five years ago after realizing the extent to which those in rural areas lacked a basic awareness about PMTCT.

"Five years ago, an HIV-positive mother we once supported gave birth to a child who was infected with AIDS," said Chung To, president of the Chi Heng Foundation.

"It made me realize the importance of promoting awareness about PMTCT to families affected by AIDS."

So far, the Chi Heng Foundation has given support to around 10 couples who managed to give birth without transmitting HIV/AIDS to their children.

When asked what still needed to be done to improve the situation, Chung had a list of suggestions. "Firstly, [one of the problems] is the discrimination faced by HIV-positive couples from medical staff. Many couples are given the cold shoulder when they try to seek advice about how to give birth [without transmitting HIV/AIDS] in clinics or hospitals," said Chung.

"Secondly, the antiretroviral medication we have access to in China is not as advanced as that in the US. The best medicine, which has to be imported from overseas, is too expensive for the government to pay for."

"Thirdly, for AIDS-infected people who cannot do manual labor, the government should provide suitable labor and opportunities to work so they can still make a reasonable living," said Chung.

Zhang added that the government needed to take greater efforts to raise awareness, both about PMTCT in general as well as the fact that antiretroviral treatment is free for all pregnant women who are HIV-positive.

As for Sun, her hopes are more immediate. The Chi Heng Foundation has promised to help pay for milk powder for her newborn son.

"I'm hoping my family can come and bring some milk powder tomorrow," Sun said while laying on the family bed after giving birth that day. "I'm excited and anxious at the same time. All I want is for my boy to be healthy."