Prevention of mother-to-child transmission of HIV requires pregnant women to obtain lifelong antiretroviral therapy (ART) to prevent transmission of the virus to their young children during pregnancy, childbirth or breastfeeding.
But one of the most demanding situations is to have certain women stay in treatment. When life is involved, a user may temporarily prevent taking ART regularly. Treatment interruptions can occur for many reasons. These come with mobility, side effects, stigma, disclosure, and not having free time to go to the clinic. Treatment interruptions can lead to a risk of HIV transmission and worse physical outcomes for both mother and baby.
Women with other mobility patterns crossing national and intranational borders have struggled to comply with COVID-19 pandemic remedying regimes. This threat was highlighted in March 2020 when the South African government implemented lockdown measures to control the spread of COVID-19. Research suggests that lockdowns have particularly reduced access to and provision of antiretroviral remedy services. One article estimated relief at 46% in 65 South Africa’s number one care clinics.
To sense the effect of the lockdown, we conducted studies with 40 women at a public hospital in Johannesburg. All were HIV-positive women and migrants on the move: they crossed national/provincial borders and/or moved within the city of Johannesburg.
The goal was to find out what their reports had been in the COVID lockdowns. We found that everyone had serious problems accessing and following treatment. They were also misinformed about the importance of maintaining treatment regimens.
However, there were differences among women on the move. For women who crossed the country’s borders, the most demanding situations included border closures and bureaucracy to access physical care. Twelve women had been on antiretroviral treatment for less than a year and were already 4 to 8 months pregnant. This remains an alarming concern for many cross-border migrants who are newly diagnosed when they first access PMTCT care in a public hospital. For some internal migrants (moving to the interior of the country), the biggest challenge is the worry of being inflamed with COVID, which kept them away from sports facilities.
The stories of those women need to be shared as countries implement long-term pandemic plans. Their views are vital in helping policymakers understand how to help patients on the move.
what did he have to say?
A common thread circulating through the stories of remedies was that most women did not perceive the need to continue with the remedy after giving birth. The majority (38) of women reported that they chose to take the medication to protect the baby’s health, but thought they could. Simply prevent after delivery, ignoring the long-term dangers and benefits of proceeding with the remedy, for them and their baby.
This lack of wisdom underscored the fact that with the COVID-19 pandemic and its increased burden on the physical care system, women had not gotten the mandatory help and counselling after diagnosis. Some women said they would have liked to get comprehensive counselling without delay. after diagnosis, especially when they started taking antiretrovirals. But there wasn’t enough space and time to give deep advice.
Most of those women knew they needed to take antiretrovirals, but they may not tell us why. While there are similarities with women on the move, some differences stand out. In reports of women with internal migration patterns, the big issues were interruption of treatment and missed appointments due to concerns of contracting COVID-19 in fitness services; public dispatch to fitness services will not be available during lockdown; and separation of patients according to their HIV status, which led to oblique disclosure.
Travel restrictions due to the lockdown have affected women with cross-border migration patterns. Alarming concerns raised included ill-treatment by gym staff; discrimination and longer waiting times in queues; shortage of ARVs; language barriers and lack of knowledge of dosages and effects of aspects; lack of schooling and counselling; and documents. All acted as barriers to caring for mother-child couples.
As one described it:
It was very hard we got on a bus and then got off to take another. This has happened several times. Before they took us to the border, we were arrested. When we arrived at the border, we were arrested again. Even after we crossed the border, we were still arrested. . . My sister had identification, but I didn’t.
What can be done?
Health systems will need to have other facilities that meet the individual wishes of women on the move.
Multi-monthly distribution and the long-term source of antiretrovirals may, in particular, increase the number of clinic visits required.
Health education interviews will be conducted in person and virtually, taking advantage of the long waiting times in the clinics. Key messages should be delivered in other languages and at a number one education point that patients can understand, empowering them through information.
Online virtual education platforms available in other languages can help women stay on treatment to prevent mother-to-child transmission of HIV. Monetary and documentation problems similar to receiving care.
Patients need more time for counseling, especially other people who start treatment the day they find out they are HIV-positive. There is usually a lot to deal with and other people need time and help to process the news.
Service providers want more in their work environment, which can help them stay informed to be more sensitive to languages and help immigrants.
Migration and fitness are not static. Health policies that announce the inclusion and sustainability of migrants are needed for the prevention of mother-to-child transmission.
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