That was the call she was expecting but did not have courage to receive. She took the phone with trembling hands. She can hear the voice from other end. I am Dr. …. She answered with feeble voice “Yes Doctor, this is Chamila. This is regarding the report. Isn’t it?” “Yes. Chamila. I know it is you but I have to make sure. Give me these details…….” After verifying her details she could hear doctors voice like coming from heaven. Chamila we have good news. Your baby is negative.” The relief…. RELIEF. Only Chamila knows what she went through during last eight months.

This was the most important period in her life. She was pregnant with her first baby. She had everything she expected in life. As any young woman she dreamt of a handsome caring man doing a decent job, a house, a vehicle and her own family. She had all. They were not the richest people, But they were contended in life with what they had. A small house, a small car and a dependable income. Within months after marriage she became pregnant. As she was 25 years and husband has passed 30 years there was no need to delay starting a family. She got registered at the area clinic. The midwife in the area kindly advised her what to do and what not to do. Then she underwent some blood tests. She read the leaflet which was in the clinic bookshelf about the tests available. She saw the poster hanging on the clinic door all these days. When she listened to the health talk given by the midwife and the sister she never felt that some of the things mentioned were applicable to her. She ignored that part completely. In her wildest dreams she was not ready to accept such possibility.

Chamila felt bit confused when she learnt that she has to undergo further testing. Only the doctor in the clinic talked to her regarding the need for further testing. She assured her of maintaining confidentiality. No one other than the doctor knew that her tests need to be repeated. She was reassured several times. The whole world turned upside down for Chamila when she learnt clearly that she has HIV. Till then she knew only a little. But with the assistance of the doctors, nurses and midwives at the field clinic and the STD clinic she started learning about HIV. She was depressed, confused,wild. She wanted to know how she got it. She has never had any sexual contact before marriage. That gives you a clear answer.

Further she had other questions. Number one; How can I inform my mother? Who expected the best in the world for me, nothing else? How can she tolerate this at her old age? Then she had other concerns. Can I trust the staff? How will they look at me? Will they think of me as a woman who behaved in socially unacceptable ways? If my neighbours and relatives get to know what will happen? What is my place in the society? What about my in-laws? She had a long list of questions popping out in her mind? Denial is the easiest.

She can commit suicide, run away from the area and behave as nothing happened. She was considering all available options. She was lucky. She had support from all corners. She never expected that sort of support from the field clinic. The doctor was attentive to her needs and spent hours with her sorting out all her issues in best possible way. Her husband was there for her. He was the first man she loved and she did not want to lose him. She knew he loved her dearly and repenting at the same time with guilt feelings. She did not want to make him feel more miserable. At the STD clinic she understood there are many options available without running away from life.

There are people to support you. Country has all the facilities. The best thing what she learnt which gave her life back was “YOUR CHILD WILL NOT GET HIV”. IT WAS A MIRACLE. YES. At the STD clinic, she was started treatment immediately. With treatment her virus level in the blood dropped to very low levels within months. By the time she was close to delivery there was a very low level of virus which could not infect her baby. The clinic had all necessary facilities. They counselled her at every visit understanding her issues. It is not only her there were many mothers who were managed earlier and few mothers were being managed during that period. She saw mothers bringing healthy, plump babies for tests and happy mothers declaring that baby is free of HIV. She gradually accepted her status with the support of her husband. They decided to face the world with their negative baby. Though both of them were positive they knew they had a future ahead. The doctors explained the services available for people living with HIV. All persons diagnosed with HIV were immediately started on treatment. If you take your treatment correctly as advised, within few months the virus level in the blood would reduce to undetectable levels. That means your immunity does not get affected. You are free from illnesses.

You will not develop AIDS. By taking treatment regularly you can avoid AIDS. It is true that you have to take treatment lifetime. But still this gives hope. Doctors explained them that they were lucky to get identified in the early period when they were having good immunity. Chamila started living life again. She still had issues, concerns which were bothering her on and off. Chamila and her husband decided to keep the HIV status to themselves. Though they were certain that they would get support from their parents they did not want to burden them in their old age.

They attended the field clinic and the area STD clinic regularly. After initial assessment regarding her HIIV status she was referred to the Obstetrician in the main hospital for management of pregnancy and delivery. All this happened with her consent and always there was a nurse in the hospital to take her to the clinics and to guide her regarding management. Chamila was sure all of them understood the responsibility of managing her while maintaining confidentiality. Her delivery was planned by the consultant obstetrician and she was advised to get admitted to hospital. The STD clinic staff guided her to keep all necessary drugs for her and baby. They even advised her how to prepare her bag for hospital admission. Everything happened according to the plan. She had a baby girl and all were happy for her.

The paediatrician of the hospital supported her to manage the baby. She was advised to take baby to the STD clinic for tests to exclude HIV infection. That is what she did. She understood the situation and knew there is support. With her husband she faced the challenges. She appreciated the support she received from all corners. She was glad that all who were involved in the management were aware of their responsibility. She was worried about confidentiality. She was worried that staff would have attitudes and would corner her. She had heard some stories. She was expecting the worst. But gradually she understood that health staff is knowledgeable on HIV than she expected them to be.

They knew she needed their support. Everybody was clear what they had to do. The doctors at the STD clinic coordinated management with the hospital staff including the nurses, Obstetrician and the paediatrician. The doctor at the field clinic (MOH) assisted her throughout. She was surprised later; after delivery the area midwife supported her to manage the baby. But the area midwife never questioned her on her status or bother her with interference. It was such a relief to understand that the area midwife is there in case she needed her support. It was a difficult time. However, she could pass that period and at the end her baby is free of infection. Can she expect anything more than that? That was all she wanted to hear all these days. Yes, she wanted to scream “MY BABY IS FREE FROM HIV”. In Sri Lanka, 80 children with HIV infection have been reported up to end of 2016. HIV infections among children are acquired from infected mothers during pregnancy, delivery or while breast feeding.

The elimination of mother to child transmission (EMTCT) of HIV is now considered a realistic public health goal. Nearly all HIV infections due to mother to child transmission can be prevented through early diagnosis, use of antiretroviral drugs, safe delivery practices and safe infant feeding practices. Timely administration of anti-retroviral medicines (ARV) to HIV positive pregnant women significantly reduces the risk of HIV transmission to their babies. It is a proven, inexpensive and effective intervention. Therefore, HIV testing is introduced to all pregnant women during the booking visit on voluntary basis. This is offered in the same screening package with VDRL, Haemoglobin, grouping and Rh and urine report. Antenatal HIV testing was scaled up island wide to provide universal screening for all pregnant mothers within few years. With the success of this programme the future generation of the country will be free of HIV.

Dr L I Rajapaksa
Consultant Venereologist Coordinator EMTCT Programme
National STD/ AIDS Control Programme
Sri Lanka