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[pronut-hiv] Botswana: HIV And Breastfeeding Stigma

  • From: "ProNut-HIV" <>
  • Date: Wed, 09 Aug 2006 10:03:52 -0400

Mmegi/The Reporter (Gaborone)

August 8, 2006
Tuduetso Setsiba

While many people remain astonished as to why the world should
commemorate breastfeeding - a practice which is a given, especially in
Africa - Juliet Rakenosi of Gweta treats the time sacredly.

To her and members of Zagobe Support Group in Nata, this is the time
when they reflect and ponder on issues that affect mothers living with
HIV and their babies.

After all, Botswana is one of those countries adversely affected by
HIV, and at some point it had the highest prevalence rate in the world.
"We do not want any new infections so we encourage mothers who enroll in
the government programme of PMTCT to adhere to the rules," she said. A
volunteer at the local clinic, she spends all other days of the week
teaching pregnant mothers the importance of PMTCT and why they should
adhere. But on Wednesdays, she visits those who have tested positive, at
their homes, checks how they are doing, encourages them to disclose
their status to their partners and caregivers.

"It is often not difficult as most of them know me from the clinic,"
she said. When she is uncertain if her client has disclosed their
status, she will wait until it is only the two of them in the house.
Exciting as it may be, there are times when her job really frustrates
her. "I have encountered cases where mothers breastfeed their babies
because they are afraid of disclosing their status to the family.
Nowadays if somebody does not breastfeed people get suspicious," she
said. Rakenosi however always encourages her clients to disclose to at
least care givers to ensure that the baby is safe.

Not only that, Rakenosi said disclosure helps mothers accept their
status. "Frustration can actually compromise one's immunity," she said.
Rakenosi said all this necessitates the need to bring along the partner
when testing for the first time so that they can be at the same level.
Rakenosi also faces a challenge of parents who fear to test their
children as per the requests of the programme. The thought of positive
status of the baby is dreadful to a lot of parents. "Many prefer not to
know, but I always insist that that they test so that the baby can get
medical attention well in time," she said. A programme officer at
Botswana Network of People Living with HIV/AIDS (BONEPWA), Merriam Kobo
concurred that lack of disclosure often leads to HIV positive mothers
breastfeeding their babies.

"When one has not disclosed her status to the partner and caregiver, it
becomes very difficult to justify why they should not breastfeed," she
said. As a result, Kobo said they always insist that women should bring
their partners when they undergo the first counselling. She stressed
that an HIV positive mother should engage in exclusive bottle-feeding. A
programme has since been initiated where mothers who undergo PMTCT
programmes come together to discuss their experiences, failures and

Male partners too have begun a programme where they share experiences.
She said that lack of support from the family - especially men, who are
often heads of families - at times makes it difficult for mothers to

"Men are not very forthcoming and we hope that as time goes by they
will fully participate in the programme," she said. Kobo has also
realised that mothers find it difficult to inform their in-laws and in
some instances their parents whom they fear might encourage them to
leave their partners. She too agreed that a policy that would protect
children whose mothers are HIV is essential.

"Children's rights can be protected by empowering the parents with
information," she said. Programmes Manager at BONEPWA, Ben Aliwa agrees
that in some instances, the health of infants is compromised in cases
where their HIV positive mothers breastfeed them for fear of stigma and

Though policy formulation to protect infants from such misfortunes is
vital, Aliwa said policy with little information on AIDS would be in
vain. "The reason why mothers in some instances breastfeed is because
their partners are not on the same wavelength as them. If men could be
taught, then this problem would be alleviated," he said. He suggested
that the name of the programme be changed from "mother-to-child"
prevention to "parents-to-child".

Aliwa argued that the current name suggests that it is a woman's thing.
He said all sectors need to be empowered, and programmes should entail
couple counselling. To curb this problem, BONEPWA has began a project
called Expansion of Psycho Social Support project that involves HIV
positive women who are trained as ARV peers to help other mothers ensure
that they adhere to treatment.

Though government has programmes in place for mothers in PMTCT, some do
not access them for fear of stigma. Some would hide the formula, which
the government gives them free of charge. In one of the health workshops
hosted by Maisha Yetu, Malebogo Malaolo, who underwent PMTCT, blamed the
health practitioners.

"Instead of giving you the formula like any other ration provided to
mothers, they call you secretly, hide and put it in black bags. That is
reinforcing the stigma that already exists," she said. From August 1-7,
World Breastfeeding Week will be observed in over 120 countries
world-wide. The theme this year will be "Code Watch: 25 years of
Protecting Breastfeeding".

World Breastfeeding Week (WBW) was initiated by the World Alliance for
Breastfeeding (WABA) and first celebrated in 1992. It is endorsed by
UNICEF, WHO and FAO. World Breastfeeding Week aims to emphasize the
importance of breastfeeding to mothers, communities, health care
providers and policy makers. Globally, over 3 million children are
estimated to be living with HIV. Many were infected either before birth,
during labour, or through breastfeeding.

These modes of transmission can be avoided through early detection of
the virus. As such, there is a growing need to implement measures that
allow pregnant women to be informed of their status prior to giving
birth and breastfeeding.