We Are Turning off the Tap in Zimbabwe

In August 2014, EGPAF-Zimbabwe Director Agnes Mahomva, M.D., was elected president of the Zimbabwe Medical Association — an honor and a responsibility that reflects her dedicated work to end pediatric AIDS and strengthen health systems. She recounts the transformation that she has seen in her country over the past 15 years.

In 1999, the AIDS epidemic was exploding in Zimbabwe—25% of the adult population was infected with HIV, 40% in the cities. Nearly half of expectant mothers were HIV-positive.

That was the year that the prevention of mother-to-child transmission (PMTCT) program was introduced in Zimbabwe as a pilot program at three sites supported by the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) in 1999.

When the pilot ended in 2001, the Zimbabwe government decided that PMTCT was a priority area, and they wanted to move forward with a national program. The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) stepped up with the resources to fund and support it. Until that moment, although everybody was extremely worried about HIV/AIDS, the focus was mostly on adults, with no one quite knowing what to do with children.

“My God … You Saved My Child”

I worked with the Zimbabwe Ministry of Health and Child Care as the national PMTCT coordinator, managing the expansion of the program. While my main focus was increasing coverage and reach, I became more and more attached to the individual mothers and children who would come to the national program events thanking us, saying, “My god, you saved my family; you saved my child.”

I have found great fulfillment in hearing their stories, knowing that this work has made such a difference.

In Zimbabwe, our culture places a lot of importance on preserving our clan. With the onslaught of the HIV pandemic, people truly felt that whole clans would be wiped away. Seeing those women coming and thanking us, saying how much the program had changed their lives made me think again that when you talk about a generation free of HIV—or a nation continuing to exist—you have to really start with the little ones first, the children.

Closing off the HIV Tap

Yes, we could get more people on treatment, but what we really wanted to prioritize was closing off the HIV tap by ending transmission of HIV to children.

There has been such massive progress with the roll-out of the national PMTCT program. When we started, the mother-to-child transmission rate was near 30 percent because there was nothing happening, no intervention. By 2009, we found out what the mother-to-child rate was down to 18 percent. Then in 2011, it was at 8.8 percent.  Now it is even lower.

While EGPAF-Zimbabwe started as a PMTCT program, our work has evolved so that now we don’t just focus on mother-to-child transmission. We are working with the Zimbabwe Ministry of Health and Child Care to support an integrated and comprehensive program to make antiretroviral treatment available in all maternal, newborn, and child centers. We are working to ensure that all women are tested for HIV at any antenatal care clinic and are put on lifelong antiretroviral treatment if they test positive. And we are working to identify and test HIV-exposed children—and putting them on antiretroviral treatment if they are HIV-positive.

We also do quite a lot of work in the community, so that women know that they need to come for treatment and that babies who have been put on treatment must come back with their mothers—what we call retention and follow up. We work very closely with community leaders to educate and raise awareness.

We are turning off the tap.

Agnes Mahomva, M.D., has been EGPAF’s country director for Zimbabwe since 2008. Today, EGPAF supports 93% of Zimbabwe’s antenatal sites. Dr. Mahomva recently coathored “Unmet Need for Family Planning, Contraceptive Failure, and Unintended Pregnancy among HIV-Infected and HIV-Uninfected Women in Zimbabwe,” which was published in PLOS ONE, an international, peer-reviewed, online publication.