TEDGlobal: Addressing HIV in Southern Africa

Annie Lennox explains why, in her excellent set at TED Global last night – she was wearing a shirt that says “HIV Positive”. Indeed, she’s wearing the same shirt today. She tells us it’s a sign that she is “in solidarity with people living with HIV” and that “we can talk about this issue, it doesn’t have to be in the closet.”

She was introduced to the issue through Nelson Mandela’s 46664 Foundation. The number refers to Mandela’s prison number during his incarceration on Robben Island. Mandela took a group of artists some years back to Robben Island to talk about HIV/AIDS, which he described as a “virtual genocide” taking place in his country.

Lennox tells us, “I’m a woman and I’m a mother, and I realized this was an issue that affected women and mothers”. And since then, she’s become an active campaigner, giving concerts to support the work of the Treatment Action Campaign, and speaking in the Scottish Parliament about HIV.

Her goal is the UN’s goal – the elimination of mother/child transmission by 2015. She shows us the photo of a smiling South African mother who is HIV positive – the woman is smiling because she knows she’s getting treatment so she can live and support her child and because the baby will go on medication to combat HIV from birth.

Mitchell Besser starts his talk with a profound image – a field of graves. He asks us to see these as a field of graves of the recent victims of HIV in an African community.

Besser observes that, of the 35 million people living with HIV, 2/3rds live in Africa. 90% of the HIV positive pregnant women are in Sub-Saharan Africa. This means that, while 8,000 mothers with HIV give birth in a year in Rwanda, a single hospital in Johannesburg sees 8,000 mothers with HIV in a year. Across the country, 300,000 HIV positive mothers give birth in a year.

There’s no reason an HIV positive mother needs to pass the disease onto her child. In resource rich countries, the infection rate for children of HIV positive mothers is 2% – it’s 40% in resource poor countries. There are drugs that are quite effective in preventing mother to child transmission, and if doctors can help women survive longer, they can raise their children.

One of the major problems in South Africa isn’t just access to drugs – it’s access to medical care. Nurses see 50 to 100 patients a day, which means they have little time to connect with their patients and listen to their needs. Besser tells us that, as a doctor, he expects people to take his advice, to have safer sex, to take their medicines. But if a woman isn’t in power in a relationship, how can she get her husband to use a condom? If no one in her family knows her HIV status, will she take her medicines? She probably won’t.

Besser tells us that the problem is that mothers are often told their HIV status, and let out of the office with the impression that their lives are shattered. How much better if one leaves the appointment and goes into a room full of HIV+ mothers – Mothers to Mothers – who reassure her that she can survive the disease and have a healthy baby?

Mothers to Mothers helps women support and educate each other about how to take the medicines, take care of themselves and take care of their babies. Patients are the experts on their own experiences – they can share this expertise, especially since Mothers to Mothers treats them and pays them like the healthcare professionals that they are. They go through weeks of rigorous, up to date training, and Besser tells us that, through their annual training programs, they’re often more up to date than doctors and nurses.

The goal is beyond education – it’s about empowering women. Mothers to Mothers opens bank accounts for their counselors and pays the women directly, keeping money out of the hands of men. In Rwanda, HIV treatment requires the men to attend, to be part of the pregnancy of an HIV+ mother. Disclosure is critically important for the success of HIV care, he tells us. And sometimes these forced disclosures lead to family members disclosing to each other that they’re HIV+, and all afraid of being thrown out of their families, due to the stigma of the disease.

The issue of doctor and nurse shortages might be addressed through “task-shifting”. This usually means moving jobs from doctors to nurses… but there aren’t enough nurses in South Africa either. So tasks shift from nurses to the mentor mothers, who explain side effects of the drugs, how women need to care for themselves and eat while on the drugs.

We need to change attitudes about the disease, Besser tells us. And we need to change a broken medical system. By redefining medical teams with mentor mothers, we can address both these problems. The program now works in 9 countries, seeing 230,000 women per month, and employing 1,600 mentor mothers. It’s a simple solution, he tells us – mothers caring for mothers, caring for babies.