A Daughter’s Journey, Part III: Mother-to-child transmission in Johannesburg

JOHANNESBURG, South Africa — From the outside, the Chris Hani Baragwanath Hospital, on the outskirts of Soweto township, looks like a prison. A metal fence with security checkpoints surrounds the hospital’s large yellow brick buildings. Despite appearances, though, this research hospital has served more than three million people. It is the largest research hospital in southern Africa and among the largest in the world.

When I arrived in Johannesburg, USAID representatives Shelagh O’Rourke and Themba Mathebula met me at the airport. They had arranged for me to visit Baragwanath Hospital, which is home to a USAID-funded HIV clinic that focuses on the prevention of mother-to-child transmission. 

Inside, the Perinatal HIV/AIDS Research Unit (PHRU) looks anything but dungeon-like. Colorful neon walls line hallways accented by blue doors that mark patients’ rooms. In the waiting room, mothers fill the perfectly aligned black seats, holding their children tightly in their arms. Some of the older children play while their mothers keep close watch. The scene is one that could be witnessed inside any pediatrician’s office. The difference, however, is that each of these mothers has HIV, and some of their children do as well.

Can you imagine being a mother, not knowing that you were HIV positive before you were pregnant, and finding out that not only might you not live to see your child grow up, but also that your baby could have the same disease?

My dad told me that he was in the room with my mom when her test results came back. I asked him if she told him the news or if the doctor told him. It was the doctor. They found out together. I asked him if he was mad, but he said he wasn’t.

“I was scared for you and me,” he told me.

My mom was scared for me too, my grandma remembers.

“She was sad that she wasn’t going to have enough time with you. I remember when she found out she burst into tears and ran into the bathroom. When she came out she said, ‘I’ll never live to see Tracy grow up.’ She knew that anybody who had AIDS died.”

In 2005 and 2006, close to 700 new patients came to the PHRU clinic each year, said resident pediatrician Dr. Avy Violary (photo below), who serves as the director of pediatric research and care at the clinic.

That’s more than 700 mothers who may have felt just like mine did.

When I arrived at the clinic I got to meet two of those mothers, one whose child was born with HIV and the other whose baby did not contract the virus.

Five-year-old Refiloe Bungase (photo left) came to the clinic with her mom, Zandile Bungase, for her three month check-up and to pick up her medication for the next three months. Zandile found out she was HIV positive in August, 2007, when she first became pregnant. At that time, the only method for prevention of mother-to-child transmission at the clinic was for the mother to take one dose of nevirapine during birth—the drug decreases the baby’s chance of contracting the virus by approximately 50 percent. For Zandile and Refiloe, the drug did not work.

Five years later, with better prevention methods and more funding for medication through USAID and PEPFAR, Nompumelelo Kunene, who is HIV positive, was able to give birth to her now three-month-old baby, Sicelo, without passing the virus to him. Nompumelelo took AZT twice a day during her pregnancy as well as a dose of nevirapine when she gave birth. It is this treatment and prevention regimen that has cut Dr. Violary’s yearly count of new patients from 700 to about 20 or 30.

The PHRU clinic has been a game changer for mothers in Soweto and an example for other PMTCT clinics throughout South Africa. PHRU and Dr. Violary are dedicated to research and application of cutting-edge PMTCT treatment, but a question remains. What will happen if the clinic loses PEPFAR and USAID funding?

Keep following my journey as I travel to Cape Town to find out what PMTCT programs are up to there. 

“A Daughter's Journey" is a series of blog posts by Tracy Jarrett, a GlobalPost/Kaiser Family Foundation global health reporting fellow. Tracy is traveling from her hometown, Chicago, to Cape Town, South Africa as part of a Special Report entitled "AIDS: A Turning Point.” Read Part I of Tracy's journey here and Part II here.