Cuba: Special Treatment to Mothers with HIV/AIDS

One of the existing conflicts for women with HIV/AIDS is pregnancy. To be a mother or not is a difficult decision and with great risks for mothers and their babies.

In Cuba, the policy of the Ministry of Health is to help mothers to take a decision giving them information and support from Specialist of various medical disciplines. The women’s right to decide is respected, and no matter what their decision is the medical collective, psychiatrist, gynaecologist, and other Specialists offer health care to women completely free of charge. If women decide to give birth they will have at their disposal the entire scientific advance in the field of research and pharmaceuticals to combat AIDS as well. This is free of charge.

When a woman with HIV/AIDS takes the decision to give birth, she should know that science has not totally erased the shadows, risks and sorrows surrounding her offspring. Either because he/she can become infected at birth or because of the painful experience of an uncertain future. However, scientific advances and some measures of protection have succeeded in reducing the risk of direct infection or prenatal infection as it is called when the infection is prooduced from mother to their children. This, for the mothers is at least a hope.

This is the process that the seropositive Cuban mothers, who have opted for the pregnancy have to go through, since 1986 when the first case of HIV/AIDS was detected in the island. By the end of 2003 hundreds of women who already knew they were carriers before or they were detected as such precisely during their pregnancy. From this group, 15 women have repeated the experience and one of them has given birth three times already.

According to Dr. Rigoberto Torres from the Epidemiology Unit of the Ministry of Public Health, behind these kinds of behaviours there is the personal determination and the right of each of these women – to decide on their descendants and also the real possibility that, by implementing certain preventive measures it is possible to reduce mother to child infection, therefore it is possible to be born healthy.

The transmission of the disease to babies is very low in the island, where there is a service completely dedicated to women-carriers who choose to be pregnant. According to the specialists, the direct transmission is 0.34% of all the cases of HIV/AIDS in the entire country. This is an indicator considered minimum, among the lowest reported internationally.

Pregnancy in women with HIV in the island is a free decision of women, who can also opt for a legal abortion to interrupt the period of gestation or continuing their pregnancy.

Every pregnant woman - as part of a routine examination- gets tested to determine if there is an antibody to HIV. If the result is positive, then the diagnosis if confirmed with Western-Blot test for HIV and they are offered counselling sessions.

Women are given information, the option of the voluntary abortion if her pregnancy has not gone over 12 weeks of gestation or the possibility of continuing the pregnancy. This procedure is taken both with seropositive women captured during the pregnancy, and those living with HIV/AIDS, have opted for pregnancy.

Specialised attention since 1989 is given to these pregnant women. This includes various measures to avoid baby’s infection: quimo – prophylaxis or treatment with medication (AZT) to the pregnant women at the 14th week of pregnancy, the delivery by Caesarean Section and the elimination of breast feeding. In this way it is possible to reduce the risk of prenatal transmission from 30 to 80%, as the international and local practice has confirmed it.

It is explained to the women that if they should not continue the treatment their babies are at a high risk of being born sick and die between 3 – 5 years of age, or to live to be a teenager, according to how their evolving pattern can be. They are also given the explanation that in cases when babies are born healthy and since there is not a definitive cure for the disease, their children will be orphaned later on.

Those who accept to continue the pregnancy and to receive treatment consume daily 500 mg of AZT until time of delivery and they enter the hospital in the 39th week of pregnancy to perform the Caesarean operation. This procedure reduces the exposure time of the baby throughout the vaginal tract in contact with his/her mother’s fluids, which reduces the possibility of infection by this via.

It is possible to be born healthy

In the entire world it is estimated that 2.6 million children are infected with HIV/AIDS and more than 13 million have been left orphaned by the impact of the disease.

The Cuban official statistics indicates that from the 183 girls and boys born to seropositive mothers at the end of last year, only 17 were detected HIV positive, 134 were discharged and the rest were kept under study. From the infected ones seven died.

Most of these babies when they are born, generally the result of their HIV tests are positive, since they have received antibodies from their mothers. This does not mean however, that they have acquired the virus, doctors say.

AZT is administrated to the new born ones in syrup form every six hours, in doses of 2mg per kilogram of weight after the first 8 hours of their birth and during the first six weeks of life.

The final diagnosis can’t be determined. After 18 months of age when children are eliminating maternal antibodies, if they are not infected and develop their own.

The criteria followed to determine when a child is infected imply the realization of various tests at 18, 24, and 36 months of age. Although these are very expensive practice, the State offers them systematic medical attention, medication and a diet high in calories, free of charge. This is a very valuable support for families of these mothers, and their descendants, who in the face of fatalities and misfortune, of their own health, do not stop dreaming, loving and to bet for their lives.

Statistical frame

 The Caribbean is the second most infected region in the planet by HIV/AIDS. However, Cuba possesses a prevalence of 0,007. This prevalence is the lowest of the region and one of the lowest of the world.

 In Cuba those who lives with HIV or AIDS, receive conscientious medical attention, free treatment and against opportunistic diseases and retroviral medication to who needs it (more than 1200 cases with bi-therapy and tri-therapy). As a result of these the quality of their life is much higher than sick persons in another part of the world, who indeed live the last period of their life and conclude their life with a lot of pain and suffering.

Why women are more vulnerable than men to get the HIV?

 The semen contains a greater quantity of virus than vaginal secretions.

 The vagina possesses mucous surface four times larger than of the penis.

 The semen can be kept in the vagina up to 72 hours, enough time for the HIV to act.

 The vaginal mucus is more vulnerable than the penis to let the virus pass.

 The vagina suffers more traumatisms than the penis, since it is more sensible and can burst any blood vessel very easily or a little stria can be opened, places through which HIV penetrates.

 During the menstrual period the conditions are more favourable to contract the virus.

 Among teenagers and women in menopause the vagina is more fragile and there is a higher risk of contamination.

All of the above make the rate of transmission from man to women 2 to 4 times higher than from woman to man. Beside the biological risk, there are social risks, such as agreeing to a sexual relationship without a condom, because men do not like to use that method of protection.

It is important to insist in that, at the moment, there are only two forms of avoiding the HIV infection, the first one is to use always condom, from the beginning to the end of the sexual act, and the second one is to keep sexual relationship with a partner of whom you are absolutely convinced that he/she is faithful and not infected. The frequent change of partner, both for women and men is today’s most concrete risk to Es to acquire this lethal virus.

Safe sex or protected sex means:

Having a mutual stable partner. And if this is not happening:

1. DO NOT have penetration skin-skin.
2. DO NOT exchange body fluids like semen, blood and vaginal secretions.
3. ALWAYS USE CONDOMS in relationships initiated or “happened” casually or although women may be protected with other form of contraceptive. Remember that other type or form of contraceptives my project women from being pregnant but not from a STI (Sexually Transmitted Infection) (This is called “to use double protection” Only the condom can protect from a pregnancy and from STI.
4. DO NOT use two condoms at a time. They do not offer more protection and they can tear up by rubbing.
5. DO NOT save condoms for a second occasion. Each condom should be used only once.
6. ALWAYS HAVE A CONDOM WITH YOU, whether, in the knapsack, in the handbag, in the wallet, for males this precaution is a golden rule that does not give occasion for chances/accidents.
7. DO NOT keep condoms in the pants’ back pocket, it can fold up and deteriorate.