Family-Centered Care: Opportunities and Challenges
By Dr. Jorge Sixpence
Xai-Xai, Gaza Province, Mozambique
May 1, 2008

Since I joined EGPAF in 2006, we have promoted a family-centered approach to HIV care and support. In an area like Gaza Province in Mozambique, where women generally do not have negotiating power with their partners and the majority of men are absent or living away from their families, implementation of family-centered care — which encourages mothers, fathers, and children to seek medical care together — remains a challenge.

Family-centered care and couples’ counseling allay the fears expressed by many pregnant women. Once a woman reveals her HIV status to her partner, she is more likely to receive the emotional and social support necessary to adhere to treatment and attend post-natal care for her HIV-exposed child. Disclosure is key to opening discussions with her partner about safe sex and condom use.

In March 2008, I witnessed firsthand the benefits that occur when an entire family seeks and receives health care services as a unit. I was performing a routine supervision visit at a health center in Gaza Province, providing technical support to a nurse attending to approximately 14 pregnant women. I was pleasantly surprised to see a man waiting in line for a pre-natal consultation with his wife and child. The nurse asked me to find out who he was with and what he was doing.

Without hesitation, the man, whose name was José*, said he was accompanying his wife, Luz, to the center, which is not a common sight in Gaza Province. I congratulated him and praised his courage and encouraged other pregnant women standing in line to bring their partners and children as well. But the reality in Gaza Province makes this difficult. As I inquired further, I discovered that of the remaining 13 women in line, nine had partners living and working in South Africa, two said their husbands were working in Maputo, and only two women lived with their partners full-time.

After waiting patiently, Luz was called in for her pre-natal consultation. The nurse and I began the counseling session and she consented to allow her husband and child to join her. We repeated the counseling session with José and he accepted HIV testing for himself and their child, Francisco. While both Luz and Francisco were HIV-negative, José’s results were positive. Luz said she was not surprised by her husband´s results because he was very sick in 2000 and hospitalized with TB. Upon learning he was HIV-positive, José did not hide his shame and regret, confessing that he had abandoned Luz in 1999 for another woman, leaving her to care for three children alone in her parents’ house. The other woman died shortly after.

At that time, José began to lose weight and had a severe cough. He had contracted TB and was all alone. Luz was not insensitive to his predicament and despite his affair, she helped him access TB treatment. When José recovered from TB, he stayed with Luz and she gave birth to a son, now two years old. Fortunately, Luz did not contract HIV from her husband.

During our consultation, Francisco had a fever and was given anti-malaria treatment. José also complained of a persistent cough, lack of appetite, night sweats, and weight loss. He was diagnosed with reoccurring TB and received medication to treat his illness. He was also scheduled for CD4 count sampling (to determine how far his HIV has progressed) and initiated anti-retroviral medication to treat his HIV soon after.

Since this consultation, not only is the entire family receiving essential medical care, but they can also better support each other in accepting and managing José’s illness.

*Names have been changed to protect confidentiality.

Dr. Jorge Sixpence joined EGPAF in June 2006. As the PMTCT coordinator for Gaza Province, he provides technical support to health staff, develops plans for PMTCT services, supervises the community program, and ensures high-quality service delivery in accordance with the Ministry of Health guidelines, among other responsibilities. Prior to joining EGPAF, Dr. Sixpence served as the Chief Medical Doctor for Chibuto District in Gaza Province.