Robinah Babirye is a recipient of care and program officer with the African Young Positives Network, a Ugandan regional group for young people living with HIV. Babirye participated in CQUIN’s recent maternal and child health meeting, which focused on supporting network countries and stakeholders to expand services for mothers living with HIV and their children.
She shares her views as a Ugandan mother on issues raised in a plenary debate during the meeting that analyzed the pros and cons of keeping mothers and their babies together for antiretroviral therapy (ART) services.
Follow-up of mothers and babies as separate clients results in loss-to-follow-up. Do you believe this is the case?
Yes, in the Ugandan context, it is possible to lose either the baby or the mother once you separate services for them. I was lucky enough to have ART services together with my baby, but not all women have that. In my interactions with other mothers, I have realized the monitoring and care of the baby drops most of the time. One thing we don’t want to miss out on is the baby’s growth and development. In addition, women on ART face many challenges going to a facility, including transport costs and accessibility to health care facilities. Combining HIV services with pediatric services, postpartum saves time by killing two birds with one stone. It is easier to support mother and baby when ART services are together.
What are your thoughts on the argument that the follow-up of mothers and babies together may increase the burden of work for health providers and impact the quality of care provided to either mom or baby?
We need to consider that even before DSD services were implemented, health care workers would make excuses for their workload. Of course, this argument isn’t new as a recipient of care, but then I look at the scenario and put myself in the health worker’s shoes.
I think we should be empathetic towards each other. We can look beyond the health workers and engage mentor mothers who can take up counseling services. We should also consider giving young mothers a clinic day.
How can policymakers design services that fully support women living with HIV to remain in care and achieve optimal treatment and follow-up, highlighting the importance of recognizing that women and mothers have unique needs that change before, during, and after pregnancy?
This is a very critical question. Let me start by discussing stigma as a leading factor that drives away all people living with HIV from accessing HIV services, especially young mothers. I struggled with stigma when I was pregnant. I looked at my situation and thought that being a single mom would be the end of me. Here I was an inspiration to the youth, without a partner and about to raise a child alone, but I decided to use my platform to show people we need safe spaces for mothers to showcase their experiences. We also need health workers providing services to change their negative attitudes. There will be no progress even if we create safe spaces for mothers if health providers continue having negative attitudes towards recipients of care.
Also, let us embrace young, vibrant people who can support their fellow mothers by integrating services that do not always need clinicians. I found it hard, getting antenatal services in one facility and ART services in another facility. Most mothers I’ve encountered in Uganda either only attend ART or antenatal services or even abandon both services altogether.
In addition, policies set should also be more client-centered. Policymakers come up with programs and tell the mothers what to do without consideration for our needs. They never really come to the community level to ask about our interests and what we want to see in policy guidelines. If recipients of care are involved from the beginning, we could have good guidelines and policies that are for us. Meaningful involvement of the mothers from the community and facility level up to the global level empowers mothers.
*This Q&A is an excerpt from a pre-recorded satellite session hosted by CQUIN at the 11th IAS Conference on HIV Science on Sunday, July 18, 2021, at 19:00 (CEST).