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All your child should get from you is your smileEpisode 18 - PMTCT

In this episode of Siyayinqoba Beat It! the serious topic of preventing mother-to-child transmission is dealt with in depth.  South Africa has had a prevention of mother-to-child HIV transmission (PMTCT) programme since 2003 yet this programme is clearly not reaching enough women. South Africa is one of the few countries were infant mortality is increasing, not decreasing mainly due to HIV-related deaths. The new National HIV/AIDS Strategic Plan aims to reduce the rate of mother-to-child transmission to 5% by 2011. As the only show presented by people living positively with HIV this matter is obviously close to the Support Group's hearts. No one wants innocent children to be infected, especially mothers. Joining us again on the show this week is Dr Majoro.

Shalom Ncala: Sanibonani, siyanamukela kuSiyayinqoba Beat It! Uhlelo lwanoba ubani esihlangene naye lapha ukuze sinqobe izingqinamba esibhekene nazo kule ligciwane lesandulela ngculaza kunye nengculaza. Samkela ithimba elikhuthazayo ninjani? Sithanda ukwamkela u Dr. Majoro ninjani? Cha Kumnandi ukuba nawe futhi. Namuhla sikhuluma ngokuthi singanciphisa kanjani isibalo sezingane ezizalwa negciwane nesandulela ngculaza. Ngo February 2008 urhulumeni wamemezela ukuthi imishwanguzo emibili ebizwa phecelezi ngokuthi yi Nevirapine ne AZT isizotholakala futhi isetshenziswe ezibhedlela zika rhulumeni ze kuvinjelwe ukuzalwa kwezingane negciwane lesandulela ngculaza. Lolu hlelo lokwelatshwa oku mbaxa mbili phecelezi i-dual therapy lwenza iningizim Afrika ihambisane nemigomo yenhlangano yezempilo emhlabeni yokuvikela ukwesulela kwegciwane ngumama kumntwana. Akhe siye eGauteng siyobona ukuthi ingaba u Siyayinqoba ubafundisa kanjani abantu ukuvimbela igciwane elikumama ukuthi lingayi kumntwana (isiZulu). Hello, welcome to Siyayinqoba Beat It! The show for everyone meeting and beating the challenges of HIV and AIDS. Welcome guys, how are you? Good. We would also like to welcome Dr. Majoro, how are you Doctor? It's nice having you joining us again. Today we're talking about how can reduce the number of babies born with HIV. In February 2008 the government announced that two drugs, Nevirapine and AZT would now be available in our government hospitals to prevent babies born with HIV. This dual therapy brings South Africa in line with the World Health Organization's guidelines for preventing mother to child infection. Let's go to Gauteng now and see how Siyayinqoba is teaching people about preventing mother to child infections.

Support group: We're well, thank you Shalom.

Dr. Majoro: Ngiyaphila Shalom unjani? Nami ngiyajabula mama (isiZulu). I'm very well thank you Shalom. It's my pleasure.

Tumi Moleko: Namhlanje sise Tsakane sizokwenza i-workshop ye Siyayinqoba ye PMTCT sino Portia (isiZulu). Today we are in Tsakane at a Siyayinqoba PMTCT workshop with Portia.

Workshop Group: Hi Siyayinqoba!

Portia Ramovha: (SeTswana) ...i-protocol entsha ithi ekuqaleni kade siyazi ukuthi umama maka pregnant manikeza i-Nevirapine kuphela but i-protocol entsha okwamanje ithi umama if pregnant at 7 months angithi i7 months yi 28 weeks. So umama bazomnikeza AZT uzoyiphuza ekuseni nasentambamba angithi. Then masekufika isikhathi sakhe sokuteta bazomnikeza i-single dose ye Nevirapine. And then ke umntanam makaqeda ukuvela naye, a child is given ini ama drops angithi, and also bazomnikeza ne AZT for 7 days ne (isiZulu). Hello everybody. How are you? My name is Portia Ramovha. I'm from the Community Health Media Trust. Every Thursday at 1:30pm. Protect yourself. Protect others. Today we are going to talk about PMTCT, PMTCT means Prevention of Mother To Child Transmission of HIV. There's a new protocol. Before we knew that a pregnant woman was given only Nevirapine. Now the new protocol says that if a woman is pregnant, at 7 months, which is 28 weeks, she gets AZT that she should drink in the morning and at night. During labour she'll be given a single dose of Nevirapine. Then immediately after birth, the child will be given Nevirapine drops. AZT will be given to the child for 7 days.

Nomsa: Ngicela ubuza ukuthi ke ma ok sengiyitholile i-Nevirapine nangu mntana sekayavela ke, uzoba right yini umntanami? (IsiZulu) Will my child be ok if I am only given Nevirapine?

Portia: ...umntanakho uzoba right ne, because nakuqaleni before kwenziwe ama studies nge AZT before ifika abantu babethola yona i-single dose ye Nevirapine. Bakhona abantwana abavelile abo mama babo banikezwa only i-single dose ye Nevirapine and baphilile ba right, nawe ke umntanakho uzophila uzoba right (isiZulu). Yes your child will be fine because before the new studies on AZT, mothers were given a single dose of Nevirapine and their children were born healthy. So yes, your child will be ok.

Lady: Umbuzo wam ukuthi if mina ngi pregnant and ngi HIV positive and futhi ngikwi treatment yama ARVs. Ngiyakwazi na ukuthi ngiwathole ama AZT and futhi ne NVP na? (IsiZulu) If I'm pregnant and HIV positive and already on ARVs, can I still get AZT and Nevirapine?

Portia: Uma ukwi treatment bazobheka ukuthi uphuza amapilisi amaphi because umuntu o-pregnant akamelanga ukuthi athathe i-Stocrine because izo cause ukuthi umntana anga fomeki kahle. Then bazokhipha i-Stocrine bakufakele i-Nevirapine beseke bazokinikeza ilona iAZT ke then ozoyiphuza 3 hourly masowuziwa ngama labour pain. Masowuziwa ngama labour pain akunakuthi uzakuphuza i-Nevirapine because it's there already ikhona kwi treatment yakho ke (isiZulu). They will first consider what treatment you are taking. A pregnant woman is not supposed to take Stocrine because Stocrine will cause the baby to be deformed. They will take you off Stocrine and put you on Nevirapine and you will take AZT every 3 hours once you start feeling labour pains. So you won't take Nevirapine on feeling labour pains because it's already in your treatment regiment.

Tumi: Ku easy kanjani ukuthi umuntu maka pregnant aye ekliniki ayithole? Yizo zonke ibhedlela na ezinayo? (IsiZulu) How easy is it for a pregnant woman to access it? Is it available at all hospitals?

Portia: La eTsakane ne ousie wa ka isibhedlela esiphana nge dual theraphy yilona yiNokuthela Ngwenya nePhulosong Kuphela. Mara nakhona awukwazi wena ukuthi uziyele ukuze uyithole kumele uhambe uye kwi local clinic lezi ezethu ezikhona la emalokshini then lapho ke kula mazokunikeza khona i=referral letter, ozoya ngayo whether eNokuthela Ngwenya or Phulosong. Then kula uzoyi access khona ke i-dual therapy (isiZulu). Here in Tsakane, the only hospitals with dual therapy is Nokuthela Ngwenya and Phulosong, but you can't just go there. You have to go to a local clinic and get a referral letter to go to Nokuthela Ngwenya or Phulosong, and that's where you'll have access to dual therapy.

Shalom: (SeSotho) What are the real issues here? What really causes the baby to contract HIV?

Dr. Trevor Majoro: (SeSotho) Firstly, the HI virus is found in the semen, not the sperm. So from male into female there's no possibility that the sperm can be infected, it's only the semen. Now when the sperm is already on the mother, after conception the only time that the baby will get infection is if the mother's blood comes into contact with the baby's blood. The important thing is the viral load. If the mother's viral load is high, the chances of the baby getting infected are high. The baby can get infected during pregnancy, during delivery, especially if the delivery is vaginal or after delivery during breastfeeding.

Nokubonga Yawa: Ngumama u-HIV positive oye wakhulelwa ne, masithi iCD4 count yakhe ayikabi sezantsi ise right. Then ayifumane le AZT then naxa eyobeleka aphinde afumane laNevirapine maybe still ade ambeleke umntanam abe HIV negative ne. Then aphinde amithe lomama maybe akakatyi zi ARVs yabona. Then ndicela ukubuza mna ingaba la AZT nala Nevirapine izakuphinda isebenze kakuhle na? because mos ipilisi xa bukhe wazitya ziyaqhelana negazi ne. Then iHIV izobe kengoku seyingayikrobelanga iyazi kengoku na iAZT ne Nevirapine ba zisebenza kanjani? (isiXhosa) Here's an HIV positive woman and she falls pregnant. Let's say her CD4 count is still high, it's aright. She gets the AZT and she's also given Nevirapine when she gives birth, and she gives birth to an HIV negative baby. Then she falls pregnant again and she's not on ARVs yet. So will that AZT and Nevirapine still work as effectively this time around because we know that your body gets used to these pills? So won't the HIV be aware of how AZT and Nevirapine work?

Dr. Majoro: Uma sibheka isikhathi sokuqala le programme ye prevention yamanje le yedual therapy ye 28 week, uma ngaba umzali uye wayithatha wa seyadiliva emva kwaloko into ebalulekile ukuthi kufanele a-monitor. In line with ama regulations sizobheka ukuthi i-CD4 count yakho ingakanani. Kaningi emva kokuthi abazali abaningi babelethe izingane i-CD4 count yabo iya drop. Beseke kula uzothola ukuthi kuze kufike la umuntu kufanele athole khona I triple therapy yonke. So kaningi abazali ku ukuthi ma ba pregnant ukuthi already seka kwi triple therapy or HAART. So ngalesosikhathi leso akusadingeki ukuthi athathe iAZT iyodwa ngalendlela bekayithathe ngayo from the beginning. Ngoba vele usuka seka thola itreatment yonke ephelele (isiZulu). If we look at this programme of prevention, this dual therapy at 28 weeks, if a woman goes on a programme, she must be monitored closely after the delivery. In line with our health regulations, we monitor her CD4 count. In most cases, after women give birth their CD4 count drops and it drops to a level where they have to take the full triple therapy. So most women are already on triple therapy or HAART by the second pregnancy. So they don't need to take AZT on it's own like they took in the beginning because they're already taking the full treatment.

Luckyboy Mkhonzwane: Like if umama uye wathatha i....wayithola i-dual therapy ne. Then kutholakale ukuthi after i-delivery i-CD4 count yakhe isese right. And then ngokuhamba kwesikhathi kufike isikhathi la i-CD4 count yakhe sekusele mhlawumbi 2 years down the line fanele ukuthi angene kwi triple therapy. Ingabe kunama chances of ukuthi angaba still like angakhona ukuthi angene mhlawumbi kwi Nevirapine futhi because ukhe waba exposed kuyo or AZT because ukhe wazithola as single dose? (isiZulu) If a mother gets dual therapy and then after the delivery their CD4 count is still alright. Then after a while the CD4 count drops, say two years down the line, and she has to start triple therapy, can she still be put on Nevirapine or AZT even though she was exposed to it as a single dose before?

Busi Maqungo: Mna when I was pregnant ngo 2002, ndaba exposed kwi single dose Nevirapine. Nge lucky ke umntana wazalwa eHIV negative right. Later on five years later kwafuneka ba mandiqalise kengoku iARVs. I-ARVs zam yi 3TC yi AZT si Stocrin. But andikahange ndi resist mna because I'm doing well kulalantuka kwi treatment. Because nyani ke iviral load yam is undetectable. Within 3months of taking ARVs yaba undetectable i-CD4 count yam has been going up (isiXhosa). When I was pregnant in 2002, I was exposed to single dose Nevirapine. Luckily the baby was HIV negative. Five years later I had to start on ARVs. My ARVs are 3TC, AZT and Stocrin. I didn't have any resistance; I'm doing well on the treatment. My viral load is undetectable. Within three months of taking ARVs, my viral load was undetectable and my CD4 count has been going up.

Dr. Majoro: I Story sakho siyabonisa ukuthi ku possible ukuthi umama anga thola i-single dose and after some time makasebenzisa itreatment angabi neresistance. Because kuyiqiniso ukuthi i Stocrine ne Nevirapine zinalokhu esikubiza ukuthi yi cross-resistance. Mangaba u developer iresistance kwi Nevirapine kusho ukuthi ne Stocrine ngekhe sizakusiza. And na ku wena ukhona uyaphila u-fresh kusho ukuthi sesiyakusebenzela (isiZulu). Your story is showing that a mother can get a single dose and not develop resistance after some time when they start treatment. It is a fact that Stocrine and Nevirapine have what we call cross-resistance. It means that if you develop resistance to Nevirapine, Stocrine won't help you either. You're here, you're healthy and fresh which means Stocrine works for you.

Shalom: Ninganyakazi sizobuya maduzane. Siyanamukela futhi kuSiyayinqoba Beat It! Sikhuluma ngokuvimbela igciwane lesandulela ngculaza elikumama ukuthi lingadluleli emntaneni. Indaba yethu elandelayo iphuma eMpumalanga Koloni makhe sibone (isiZulu). Don't go away, we'll be right back. Welcome back to Siyayinqoba Beat It! We are talking about preventing mother to child infection. Our next story is from the Eastern Cape, let's take a look.

Amanda Funani: Sise Lusikisiki sizakuthetha noThandeka ngomntanakhe ne programme ye PMTCT (isiXhosa). Today we are in Lusikisiki to talk to Thandeka about her child and the PMTCT programme.

Thandeka Vinjwa: Umntana ndambelekela eKapa kuba ndandi attend iPCR training yakwa TAC, kuba ndi volontiya as iTreatment Literacy Practitioner and also icommunity media practitioner. So ndalunywa ke ndise Cape Town at 7 months. Ndabe sendi admit kengoku e-Somerset Hospital. Then umntana yena wayefumana i-Nevirapine drops kunye ne AZT for i7 weeks bemnika two times a day iAZT. Then mna ke kuba sendi already on treatment ndisitya i3TC, Nevirapine and d4T. Ayikho into abandinika yona because sendi already on treatment (isiXhosa). I gave birth in Cape Town because I attended PCR training at the TAC, because I'm a volunteer as a Treatment Literacy Practitioner and also as a community media practitioner. So I felt labour pains in Cape Town at 7 months pregnant. I was admitted to Somerset Hospital. My child was given Nevirapine drops immediately and AZT twice a day for seven weeks. I was not given anything because I'm already on treatment. I'm on 3TC, Nevirapine and d4T, so I was not given anything.

Amanda: Waziva kanjani ukuba umntana wawumbelekele eKapa apho kusetyenziswa idual therapy? (isiXhosa). How did you feel about giving birth in Cape Town where you had access to dual therapy?

Thandeka: But kuba ndabelekela eKapa lonto yandenza ndavuya kakhulu because umntwana wam ndandimazi ba amathuba okuba asuleleke yi HIV anagaphantsi kwe 1% because ndifumene iNevirapine ne AZT (isiXhosa). I was very happy that I was in Cape Town because I knew the chance of my baby being infected with HIV is below 1% because of the Nevirapine and AZT.

Amanda: Wazi kanjani ukuba umntana u negative? (isiXhosa) How do you know that your baby is negative?

Thandeka: After six weeks ndaye ndamsa e village clinic endiyisebenzisayo eyokwenziwa iPCR test. Ejongana ncamashi nokuba ingab unayo na intsholongwane kagawulayo egazini lakhe. So iresults zibuyile kengoku zisithi umntana u test HIV negative that is akosulelekanga yintsholongwane (isiXhosa). After 6 weeks, I took her to the village clinic where I got a PCR test. This test checks for HIV presence in her blood. So the results came back negative which means she is not infected with HIV.

Amanda: Ungakwazi ukusicacisela umahluko phakathi kwe PCR nezinye itest? (isiXhosa) Can you explain the difference between PCR and other tests?

Thandeka: uPCR yena yitest esetyenziswayo ebantwaneni abaneminyaka e less than a year etshekisha intoyokuba ingaba umntana wosulelekile na yintsholongwane kagawulayo. Ukanti u Elisa yena uye ajonge intoyokuba ingaba i-antibodies zika mamakhe zinayo na intsholongwane kagawulayo. So akako good u Elisa for ukutshekishwa iHIV ebantwaneni because ebeqala yena atshekishe i-antibodies. Because umntana mos uyambeleka ne abe kula 6 weeks esasebenzisa i-antibodies zika mamakhe zingeka develop ezakhe (isiXhosa). PCR is the test we used for babies younger than 1 year old. It tests if the child is infected with HIV or not. The Elisa test checks for HIV in the mother's antibodies. Elisa is not accurate to check for HIV in babies as it tests the mother's antibodies. When a baby is born, that baby still uses the mother's antibodies for the first 6 weeks of life.

Amanda: Apha eLusikisiki uhamba kanjani u-PMTCT? (isiXhosa) How is the PMTCT programme in Lusikisiki?

Thandeka: Xa ndise Eastern Cape umntana wayezakufumana i-single dose eyi Nevirapine of which kengoku I guide lines zithi umntana bekufanele ba ufumana i-dual therapy but u government wase Eastern Cape akakayi initiate yena lonto. Siyamcela intoyokuba makakhawulezise ayi initiate i-dual therapy because abanye omama abantwana babo ba tester positive kuba iviral load zabo omama babo ziphezulu uyayibona. So iAZT kengoku xa izakusebenza ne Nevirapine zizaba effective in a way ba abantwana bangakwazi ukosuleleka (isiXhosa). If I was here in the Eastern Cape, my baby would only have gotten single dose of Nevirapine even though the guidelines states that the baby should get dual therapy. The Eastern Cape government hasn't initiated dual therapy yet. We urge government to initiate dual therapy quickly because some babies still test positive when their mothers' viral load is high. AZT and Nevirapine is an effective way to prevent babies from being infected with HIV.

Pholokgolo Ramothwala: (SeSotho) In the insert they say that dual therapy reduces the chances of the baby getting HIV by up to one percent. I don't understand how it works, what does it mean?

Dr. Majoro: (SeSotho) ...if kungenziwanga lutho bangatholanga amapilisi. Manje asibhekeni lo 30 percent lo ukuthi mangabe kusetshenziswa i-single dose ye Nevirapine Kuphela, half yaleyo date leyo izothola i-infection half yabantwana. Kodwa ke ne dual therapy from le engu 15 iyephantsi futhi ku less than 5 percent. Futhi siyazi ukuthi umangabe kungenzeka ukuthi athi umama nomntana bathole leyo preventive therapy, aphinde futhi umama ayenziwe lokhu ekuthiwa yi elective caesarian section, ukusho ukuthi yenziwe before aya into labour. Iyehla kakhulu even more so irisk iba less than 2 percent. (isiZulu) Firstly, out of a hundred pregnant women who are infected with HIV we know that only 30 percent of them will give birth to HIV positive children if they're not given any pills. Now let's look at this 30 percent, if we use a single dose of Nevirapine, only half of those babies will get infected. With dual therapy, that 15 drops to less than 5 percent. If the baby and mother get this preventive therapy and the mother gives birth through elective caesarian section, meaning that it's done before she goes into labour, the risk further drops to less than two percent.

Busi: Since apha eSouth Africa ingasebenzi i-dual therapy ingekho kuzo zonke indawo ikwindawo ezimbalwa ezinje nge Western Cape. How about ba istrengthen iye nakwezinye ilantuka ibekhona ndawo zonke? (isiXhosa). Since dual therapy is not available nationwide here in South Africa and only available in places like the Western Cape. How about we strengthen it and make it available everywhere?

Dr. Majoro: If ubheka iNational Strategic Plan sethu which is a very great document, especially if inga implementwa ngalendlela ebhalwe ngayo. The intention ukuthi by year 2011 ireduction of mother to child transmission should be less than 5 percent. Njengoba bubalile ukuthi kwezinye indawo ayikabi available, kubalulekile kakhulu ukuthi njengoba sesazi thina esila nabanye le vangeli silifafaze futhi silikho silwela amalungelo empilo abantu ngoba umhlaba wethu unjenje namhlanje sikulwele lokhu (IsiZulu). If you look at our National Strategic Plan, which is a very great document, especially if it was implemented the very same way it's written. The intention is that by year 2011 the reduction of transmission from mother to child should be less than 5 percent. Like you said, dual therapy is not available in some places. So it's important that those of us who knows about these things spread the word and keep fighting for the right to health because we fought to get where we are today.

Busi: But nathi ukusebenzisana kwethu nale programme ye PMTCTC we need intoyokuba si teste singomama, because awukwazi ukuba kwi PMTCT programme ungakhange utestwe okokuqala. The first step kuku-tester and know your HIV status (IsiXhosa). To work with PMTCT programmes we also need to get tested as women because you can't be put on PMTCT programmes if you don't test. The first step is to test and know your HIV status.

Dr. Majoro: But lento eniyishoyo mina -raiser ama issues athizeni. Into ebalulekile yi responsibility yethu and i-responsibility yi ability yoku responder. So i-ability yoku responder uresponder to what... The first thing you respond to ukuthi uma upregnant that is evidence of unprotected sex and because it's unprotected it's important ukuthi uteste. ...then you go through iprogrammes ezizokusiza. I think masiyi approacher kanjalo izolunga yonke lento (IsiZulu). What you're saying now raises a number of issues. The important thing is taking responsibility and responsibility is the ability to respond. Ability to respond to what...the first thing you respond to is that if you are pregnant, that is evidence of unprotected sex, and because it's unprotected, it's important that you test. When you test you know that if you're HIV positive you can go through the programmes that will help you. So the primary responsibility is your ability to respond to your exposure, which in the case of pregnant mother is the pregnancy itself. So let's start there and after that we can look into processes and mechanism which are in place and say I need that as a mother and that is not in place, how I get my community to ensure that my rights to health are in place because there's a gap there. I think if we approach it like that everything will be fine.

Shalom: Akhe sithathe ikhefu, siyabuya khona manje. Siyanamukela futhi kuSiyayinqoba Beat It! Sikhuluma ngokuvimbela igciwane lesandulela ngculaza elikumama ukuthi lingadluleli enganeni. Akhe ukuthi indaba yethu elandelayo ithini (IsiZulu). Let's take a quick break, be back now. Welcome back to Siyayinqoba Beat It! We're talking about how we can prevent mother to child transmission of HIV. Let's take a look at our next story.

Vuyo Nibe: Namhlanje sikwa Langa Clinic sizova ngenkqubela ye PMTCT ba ihamba njani na. Makhe siyokuva (IsiXhosa). Today we're at Langa Clinic to learn more about their PMTCT programme. Let's go inside.

Funeka Adelaide Ratsibe: Ehh! Siqale apha kwa Langa nePMTCT ngo 2002. Sinamanani nje amancinci oomama abezayo. Ndiqonda apho yenziwe kuba mhlawumbi oomama bebesaqala ukuva ngalenkqubo yokhuselo lwabantwana. Besiza bengezi abanye bengekakwazi nokuvuleleka ukuba bathethe ngemeko yobu positive babo nalentsholongwane ugawulayo (IsiXhosa). We started our PMTCT programme in 2002. We had a small number of mothers coming to the programme. I think that was because this whole PMTCT thing was still new to people. Some would come and some were not open to talking about their HIV status.

Vuyo: Ingaba yintoni ocinga ba yenze utshintsho kule Programme ye PMTCT? (IsiXhosa). What do you think has made a difference in your PMTCT programme?

Funeka: Sigxininisile ekubeni sifundise sibafundise apha xa befikileyo saba organizer abantu abazakuma pha phambi komama pha entantsikeni eholweni xa besalindile phayana. Siqhubekeka kulamfundiso bebeyifundile bebeyinikwe pha kwelacala lokubelekisa (IsiXhosa). We put emphasis on educating mothers when they come to the clinic and we organized people to hold talks in front of them in the waiting area. We tried to add on to what they had been taught at the maternity ward.

Vuyo: Ingaba oomama bayeza kakhulu kunakuqala? (IsiXhosa) Are you seeing more mothers now compared to before?

Funeka: Bayebekhula oomama siyababona amanani aye ekhula 2003, 2004 and ngokujonga kwethu nalapha kwi results zethu zabantwana esibakhatheleleyo apha xa simana siba tester nje. Amanani ayemaninzi ngo 2002 aye esehla 2003 and 2004. 2005 biba ngu 1 ngenyanga o-positive, ngoku mna ndilapha kulonyaka ndifumene wamnye qha. It means ukhula nje kakuhle. Baseza kakuhle oomama bandile bababaninzi bayeza nabezinye iindawo siyabaganga nabavela koma Delft, nabavela koma Khayelitsha nabavela mhlawumbi koma Wynberg siyabaganga apha sibancede. Inkqubo yethu yokukhathelela umama nomntana ikwizinga eliphezulu ngoku. (IsiXhosa). The number of mothers coming here increased from 2003 and 2004 and also looking who were testing HIV positive, we had huge numbers in 2002. They started dropping from 2003 and 2004. In 2005 we had one child testing HIV positive a month. This year there's only one child testing HIV positive. Mothers are coming through in huge numbers. They're coming in from different areas, we welcome them, some are from Delft, Khayelitsha and even Wynberg, we welcome and help everybody. Our PMTCT programme has been very successful.

Busi: Nakukhumbula intoyokuba ndandikhe ndabelana nani intoyokuba kwa Langa since sathi safika sizi TLPs senza i-educations phaya ebantwini. Abantu okokuqala beza ngobuninzi, not only ukuzo consulter oogqirha but also ukuzomamela kwimfundiso esizenzayo which is a beautiful thing. And abo bantu bayazisebenzisa ezo zinto esibafundisa ngazo because recently okokuqala uLanga uwine ama-awards. Uwine i-awards kwi uptake ye PMTCT since safika, uwine I award kwi uptake kwi adherence ye ARVs into eyayingekho leyo ngaphambili. Siyibonile isenzeka ndiyibonile mna isenzeka ngamehlo am i-awards nazo ziyayingqina lonto leyo yokuba umsebenzi we community health workers uyasebenza (IsiXhosa). You will remember that I once shared with you that since we started at Langa Clinic as TLPs (Treatment Literacy Practitioner) to teach at the clinics people started coming in huge numbers, not only to consult the doctors but also to listen to our education which is a beautiful thing. People really use the information they get from us because Langa Clinic has recently won a number of awards. They won an award for their PMTCT uptake since we started working there. They won an award for their ARV adherence, something that never happened before. We saw things improve, I saw it with my own eyes and the awards are evidence that community health workers are doing a good job.

Shalom: First of all congratulations Busi, uyabonakala umsebenzi owenzekalayo. If ever sizothola i-insert efana nale unesi asitshele ama successes elokunjana e education it's very, very encouraging to some of us. What really worries me kakhulu-khulu Doctor....(IsiZulu) (SeSotho). First of all congratulations about the work you guys are doing. If we get inserts like this one where a nurse talks about successes of education, it's very encouraging to some of us. What worries me about this is accessing to testing. Why don't we make it a routine offer or something mandatory, to save the babies? That's the only question I think we should concentrate on. Women should be tested mandatory when they go to the clinic so that we can save lots of babies. There's no need to be selfish as adults and just stand back and watch children getting sick from HIV.

Dr. Majoro: (SeSotho) We have to encourage routine testing because like you said, when you're pregnant it's not about you anymore. So if we're think about the babies we're carrying, we must make sure that they're healthy. So the important thing is that the clinic or hospital should offer you a routine test. When you look at voluntary counseling and testing, it's not as easy as people think. If you look at people who have tested for HIV and if you ask you'll find that only few volunteered, people test because of circumstances. You test because of insurance, you test because you want to buy a house and you test because of other things, so volunteering is not an easy thing. Exactly, and maybe they're too sick. So offering routine testing to anybody who comes to the clinic, especially a pregnant woman would be a good thing.

Shalom: (SeSotho) Some people test because they're sick.

Busi: ....babengazi nto abantu that's why babesiza kancinci abantu. Now that kukhona kengoku abantu ebenza i-educations abanje ngathi, abantu beza in big numbers ukuzozithatha. So ke I think ndingqinelana nawe xa usithi information ibalulekile because ungabi na information sometimes can be deadly (IsiXhosa). In the beginning, people didn't know much, that's why they were coming in small numbers. Now that there are people doing education, people like us, people are coming in big numbers. So I agree with you, information is vital because lack of information can sometimes be deadly.

Shalom: Ukuze sifike lapho sikhona manje ekutheni loluhlelo lokwelatshwa olumbaxa mbili selutholakala sihambe indlela ende kakhulu. Kodwa ke kusenendlela ende ekusamele ihanjwe ukuze zonke lezizidingo ngqangi zoomama abazethwele zitholakale. Siyabonga bakwethu, kusho lukhulu kithi ukuzwa ngani. Sinxusa ukuba nisithumele izindaba zenu nenifisa ukuphawula ngako kuleli kheli elivela kumabonakude. Khumbula, Zivikele uvikele nabanye. Kuze kube ngalesosikhathi, bye, bye! (IsiZulu). With dual therapy now being available we have come a long way but we still have a long way to go to rollout these services to all pregnant women in need of them. Thanks guys, we love hearing from you. Send us your views and comments to the details on your screen now. Remember, protect yourself and protect others! Until next time, goodbye!

Support Group: Bye!