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One Project Can Change the Fate of Many People

The Healthy Mother, Healthy Child project has concluded. It took place from June 2015 – June 2016.   During the project the barriers for HIV…

The Healthy Mother, Healthy Child project has concluded. It took place from June 2015 – June 2016.

 

During the project the barriers for HIV positive pregnant women and recent mothers to receive care in medical and social institution were studied. The research took place in the Astrakhan, Ivanova, Leningrad, Novosibirsk, and Tumen oblasts as well as in Krasnodar and Khabarovsk krai, in the republics of Tatarstan and Bashkortostan, and in Saint Petersburg. The number of respondents was 988.

 

Contraceptive use of HIV positive women:

 

Condoms – 44%

 

Intrauterine Device – 6,8%

 

Oral Contraceptives – 3%

 

Coitus Interruptus – 13,5%

 

No contraception with no intent of conception – 18.1% (often the excuse indicated is HIV+ partner)

 

85 % of pregnancies were ‘accidental’, unplanned without any use of contraception.

 

Access to breastmilk substitutes (BMS):

 

89.5 % were aware of the possibility to receive BMS, 56.7 % received BMS, and 203 % received the full quantity of BMS. Therefore only 25 % of the HIV positive women surveyed in 10 regions of the Russian Federation received breastmilk substitutes as part of the program to prevent HIV transmission from mothers to children. The other three fourths of the total purchased expensive milk formula on their own – at an average monthly cost of 4,900 rubles.

 

Main findings from the research:

 

— High levels of poverty (need for assistance in receiving benefits and BMS)

 

— The situation with discrimination in medical institutions has improved compared to 2013-2014 with the biggest change being the absence of markings on the cover of medical charts.

 

Support from close friends/family is more meaningful for women who just learn of their status; once they start treatment, support from doctors and peer counselors is more important

 

HIV+ women continue to use ineffective contraception methods, evidenced by unplanned pregnancies

 

The number of partners who are unaware of their status has decreased

 

HIV+ women often do not visit necessary doctors. It is worth identifying what hampers them from doing so

 

Comments from project leader Natalia Utrovskaya:

 

“In our organization there has long been an unofficial slogan: ‘EVA always must be a little bit pregnant’. Therefore this project, Healthy Mother, Healthy Child, has proved to be unbelievably successful due to its inexhaustible relevance: pregnancy, childbirth, and care for infants – these issues are as eternal as the earth. Women always gave birth and will give birth despite poverty, wars, catastrophes, and epidemics. Over the year of the project’s implementation, 1,429 pregnant women and women with small children in Tumen, Khabarovsk, and later on in Vladivostok, partook in the program. Among the project’s participants there was not one newly registered case of HIV infection in children.

 

The project is based on the work of peer counselors paired up with social workers. Twice a week they received pregnant patients and patients with small children directly in an office within the AIDS center building (this was one of the project’s conditions). They also worked remotely through counseling by phone and house calls. The main wave of patients came from gynecologists, infectious disease doctors, pediatricians, and psychologists. The timeframe when a woman learns of her pregnancy until the child is removed from the AIDS center’s lists takes at least 25 months.

 

Over the course of this entire period not one doctor or nurse, even in the most equipped circumstances, can not continuously support women in particularly challenging times, when she must ask questions and timely receive a detailed response. Our project worked to fill this gap. The demand for peer counseling services came directly from the heads of the AIDS centers and the project turned out to be a pilot project in that previously if peer counselors worked, they were located either remotely from AIDS centers or they counseled all patients with HIV, without directly defined skills to counsel and support HIV positive women who are pregnant and/or with small children.

 

As it often happens with successful projects, we decided to offer the previously developed model to the leadership at the AIDS centers in different regions of the Russian Federation. Happily the next project, which is set to start in the fall of 2016, has the same design but will be expanded to more regions. The next phase will take place over the course of a year until the fall of 2017.

 

We hope that the collected results contribute to the strengthening of the role of peer counselors in AIDS centers as a valuable specialist whose purpose is to assist patients with HIV in coping with their status and more positively get on treatment as well as give them support for both their own health as well as that of their future and current children.”

 

Additional barriers revealed during the project:

 

The geographical distance of villages where HIV positive women live from AIDS centers where they receive treatment. In Tumen and Kvabarovsk krai, patients must travel over 250 kilometers each way bi-monthly in order to receive ART. The project allowed for ART delivery to villages. House visits were conducted only following written agreement between HIV positive women and project employees. In order to conserve materials, the staff created a monthly route in accordance with the number of clients. On one trip they could make  5-11 visits, deliver ART, and counsel. This appeared to be one of the most important components of support for pregnant women and women with small children’s adherence to treatment in remote villages.

 

Equipping rooms or children’s areas in AIDS centers, which allows women to visit their doctors with their children and leave them under the supervision of a staff member. In implementing the project it became clear that in Khabarovsk and Primorsky krai AIDS centers there are currently no free areas to organize even the smallest children’s area and therefore the decision was made to purchase tablets with developmental games for children.

 

The phenomenon of ‘AIDS dissidents’ is widespread, especially in remote areas of the country. Project staff members worked closely with gynecologists and specialists from the maternity ward. In each case when a pregnant woman refused to take her treatment, the doctors sought out assistance from the project’s peer counselors. The decision was made that peer counselors would regularly visit the maternity ward to motivate women to be responsible for their motherhood. The participation of a peer counselor, who herself had already gone through pregnancy and labour as an HIV positive woman, in the life of pregnant women had a positive impact on the woman’s ability to cope with their diagnosis and give birth to healthy children.

 

Success stories:

 

A staff member in Khabarovsk began to visit an orphanage outside the project to support an HIV+ teenager. The girl’s name is Dasha and she is one of the first adolescents in the region who was abandoned by her mother immediately following birth. Currently there are five HIV+ children in orphanages in the Khabarovsk krai. Dasha, 12, is the oldest of them, and her chances of being adopted are fewer and fewer. She is still unaware that she has HIV due to high levels of discrimination of HIV+ people in the region, which plays into the fact that she has not yet been adopted. However, in one of the monthly reports the Khabarovsk staff member wrote about this girl. The project coordinator in Saint Petersburg contacted the Moscow foundation Children Plus and Dasha will likely be able to find an adoptive family where her HIV+ status will not be seen as an awful illness, but simply as a small particularity of this smart and beautiful girl.

 

Sometimes it happens that one project can change the fate of many people in different corners of the country…

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