BUJUMBURA, 12 August 2011 (IRIN) - A shortage of health facilities and health workers, frequent drug shortages and a weak government policy mean HIV-positive pregnant women in Burundi often give birth without taking any precautions to prevent transmission of the virus to their children.
"When a baby is born [to an HIV-positive mother] we face difficulties, as we don't have enough hospitals to treat the children from such parents," said Dr Cïline Kanyonge, head of the prevention of mother-to-child HIV transmission (PMTCT) programme in the Ministry of Health. "To get polymerase chain reaction tests [a highly accurate test used for infant HIV testing], we need to collect all blood samples in the whole country and send them once every month or two to Rwanda, where there is a laboratory that can handle these tests."
According to a 2010 UN Childrens Fund (UNICEF) factsheet [ http://www.unicef.org/aids/files/Burundi_PMTCTFactsheet_2010.pdf ] on PMTCT in Burundi, an estimated 40 percent of pregnant women get tested for HIV, but in 2009, only about 12 percent of an estimated 15,000 HIV-positive pregnant women and 9 percent of HIV-exposed infants received ARVs to prevent transmission. While this represents an increase from 2008 - when just 9 percent of HIV-positive pregnant women received ARVs - it means the vast majority of women still risk passing on the virus to their children.
The government is committed to reducing mother-to-child HIV transmission by 50 percent by the end of 2011, but given the sluggish progress of the programme, this is highly unlikely. With a population of about eight million and HIV prevalence of about 3.3 percent, Burundi - one of the poorest countries in the world - has just one doctor [ http://www.irinnews.org/report.aspx?reportid=89186 ] per 34,744 people and two nurses per 10,000.
More than 90 percent of Burundian women attend antenatal clinics at least once during each pregnancy, but the rate of skilled attendants at birth is low at 34 percent; urban women - who make up less than 10 percent of the population - report 75 percent access to skilled attendants at delivery, compared with 32 percent for rural women.
In addition, the country has experienced frequent ARV shortages [ http://www.plusnews.org/report.aspx?reportid=92363 ], so even when women do seek out PMTCT services, they may not have access to vital drugs, while poor women who require nutritional support for themselves and their children often go hungry.
"It has become difficult to get treatment as the associations that give us ARVs say there is not enough money to service all those in need," said Imaculïe Nyabenda, who has registered for PMTCT but is unsure of accessing the entire package. "[There is] no food, no milk for HIV-positive people under PMTCT due to poverty - the associations can't satisfy every one.
"What the government offers a lot to patients is counselling, but counselling is not enough as we can't get food, ARVs, and especially access to PCR tests for our newborns," she added.
According to the ministry's Kanyonge, the lack of male participation in their partners' pregnancies was a hindrance to the PMTCT programme.
"When women come to see the doctor about HIV, most of the time they are alone and this makes it difficult to achieve our goals; all these men who don't understand that they are full actors in PMTCT must be sensitized," she said.
"The government should plan how to sensitize people, using more effort and means to achieve more; only newspapers and radios talk about HIV and PMTCT, but also not [often]," she added, noting that particular attention needed to be paid to rural areas, where the majority of the population lives.
According to UNICEF, primary HIV prevention among women of child-bearing age, improved access to skilled attendants at birth, increasing the number of sites offering the full range of PMTCT services and improving general maternal and child health services would all contribute to a significant reduction in mother-to-child HIV transmission in Burundi.