Mother & Child Counseling &Testing Services in Large Demand in Sudan

February 6, 2011 -- At 10 in the morning, the counseling and testing center for Prevention of Mother to Child Transmission (PMTCT) in downtown Omdurman on the western fringe of the Sudanese capital Khartoum, is abuzz with activity. Fatima (name changed), has just volunteered to be tested for HIV infection. The counselor informs her that she has tested negative. She adds a word of advice to Fatima before seeing her off.

The PMTCT center was set up in 2005 with support of the UNDP-managed Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) in Sudan. It is part of the Omdurman Maternity Hospital that handles an estimated 26,000 deliveries every year. On any given day, close to 200 women seek counseling services for prevention of HIV transmission at the PMTCT center.

Since the Omdurman PMTCT center opened its services in 2005, a total of 53 women have tested positive. "The demand for preventive mother to child treatment and counseling services is soaring every day. We are struggling to keep up", says Dr. Salah Ibrahim Abdul Rahim, the consulting obstetrician at the Omdurman hospital. "Of all the pregnant women who sign up for counseling services, about 50 per cent fear they suffer symptoms of HIV. We are sitting on a time bomb and we must do something about it", says the doctor. He said with just a part-time lab technician volunteer and two counselors, the PMTCT staff is grossly inadequate and highly stretched. Worse, the supplies are erratic. Testing reagents, gloves, kits and syringes are never nearly enough. "We want a much stronger political resolve to deal with the HIV, which translates into more staff incentives and facilities to deal with preventive mother to child transmission", says Amal, one of the two counselors working at the center.

In a society burdened by low human development indicators, widespread illiteracy and high levels of disempowerment, that leaves little space for women to negotiate safe sex, Sudanese women find it difficult even to access primary health care facilities, let alone be counseled on HIV. The Omdurman PMTCT center, housed inside the maternity hospital provides just the kind of private space women need to access testing and treatment services that gives women and their new-born babies the hope to survive.

After Amal finishes her early morning group presentation she shares information about services available for pregnant women at the center. Routes of HIV transmission, preventive behavior, signs and symptoms to look out for, counseling and testing services, all these form part of her daily spiel to women. Out of the 100 or more pregnant women who attend the group session close to 40 visit Amal later for one-on-one counseling session. All of them volunteer to get tested for HIV. 40% is an alarmingly high percentage of women who feel vulnerable to HIV in one way or another.

For Counselors like Amal, it is part of their daily challenge to ensure that women are assisted to navigate safely through family restrictions and allowed to benefit from the free HIV-related treatment, care and support provided by the Government of Sudan under the Sudan National AIDS program (SNAP). Dina (name changed), a 21 year old pregnant mother from Gedarif, came to the center to test for HIV when she noticed symptoms of a sexually transmitted infection. Dina tested positive.

The result shocked Dina. Fearing persecution, she pleaded with Amal not to reveal her status to her husband. Amal found out from Dina that her husband, who was married twice before, was regularly indulging in promiscuous behavior. Having reassured Dina of the confidentiality of her status, Amal asked Dina to bring her husband Abdul over next time she came to the hospital for her ante-natal check-up. He needed to be tested too. The husband agreed to be tested for HIV but did not want his wife to know his status. Amal assured him that the couple would be tested together and that no separate test had been administered on Dina before. Both tested positive. Their child tested negative. Abdul grudgingly accepted his status but insisted that he receive his report separately without the knowledge of his wife. Amal accommodated his wishes but not before she convinced Abdul to own up to the behaviour that led to his positive status. Amal's deft handling of the case enabled her to shift the circle of blame and shame away from Dina and reduce the burden of stigma that women like her face often when they test positive for HIV.

Dina's story poignantly illustrates the dilemmas and difficulties faced by health workers like Amal in dispensing much-needed counseling services and providing treatment, care and support for people living with HIV.

According to the comprehensive epidemiological and behavior review of the HIV and AIDS situation in Sudan (August, 2009), the overall HIV prevalence is estimated at 1.12 per cent and expected to increase to 2.29 per cent by 2015. Data from the estimation and projection for this reporting period for North Sudan showed that in 2009, the total number of adults and children living with HIV was about 122,216; these include 117,109 adults (ages 15+) living with HIV and AIDS, 67,661 women (ages 15+), 5,107 children (ages 0-14). There are 27,888 AIDS orphans (ages 0-17), currently living with HIV and AIDS in North Sudan.

Since, 2003, the UNDP Global Fund Sudan is engaged in supporting the Government of Sudan in its fight against HIV, targeting all sectors of the community. To promote antenatal care and help reduce transmission of the infection from a HIV positive mother to her child, the Global Fund has supported the establishment of 12 PMTCT centers in 10 states of the North, offering testing and counseling services for women who approach the centers. UNDP Global Fund has allocated a total of over USD 1.3 million to realize this goal. Until March 31, 2010 a total of 21, 787 women completed counseling and testing process using Global Fund resources.

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