'Best-Kept Secret' For HIV-Free Africa

Lilian Akoth Juma, 27, a mother of six in western Kenya who has HIV, said she had lacked the means and the knowledge to use birth control.
Lilian Akoth Juma, 27, a mother of six in western Kenya who has HIV, said she had lacked the means and the knowledge to use birth control. (By Craig Timberg -- The Washington Post)
By Craig Timberg
Washington Post Foreign Service
Sunday, December 16, 2007

NDORI, Kenya -- Giving antiretroviral drugs to pregnant women has long been celebrated as one of the few successful tactics in the war against AIDS in Africa. A single pill for a woman in labor, followed by a sip of syrup for her newborn baby, cuts HIV transmission rates by more than half, potentially saving the lives of millions of children.

But despite sustained financial and political support for the effort, studies show that only about one in 10 infected African mothers has access to the drugs.

As these programs falter across the continent, researchers increasingly agree that far more cases of pediatric AIDS could be prevented with a cheaper, easier and more effective alternative: birth control.

"It tends to be the best-kept secret in HIV prevention," said Ward Cates, head of research for Family Health International, a nongovernmental organization based in North Carolina that has extensive experience in Africa.

The group has found that programs providing antiretroviral drugs to pregnant women prevented 101,000 cases of pediatric HIV between 1999 and 2006. Contraception, meanwhile, averts the births of 173,000 infected babies each year, the group says.

Improving birth control availability in Africa, where usage rates are the lowest in the world, could prevent tens of thousands of more infections more reliably and less expensively than antiretroviral drugs, Cates said. Surveys among women who know they have HIV show most do not want to become pregnant again because they fear infecting their babies and leaving even healthy offspring as orphans.

Yet as research has mounted about the importance of contraception in controlling pediatric HIV, U.S. and other international funding for birth control programs has declined. The budget President Bush has proposed for this year is less than one-third the amount spent in 1995, when adjusted for inflation, according to statistics compiled by Washington-based Population Action International, which lobbies for better family planning programs worldwide.

The shift has contributed to the stagnation of contraceptive access in some areas and outright declines in western Kenya, where programs funded by international donors once helped women resist strong cultural pressure to have many children. Women here say they have little choice other than to risk giving birth to children doomed to develop AIDS.

Lilian Akoth Juma, 27, who has wide cheekbones, short braids and eyes wearied by seven hard years of widowhood, said she did not want to have more babies after learning she had HIV in 2004.

"I wanted to be done," Juma recalled as she sat in her dark, dirt-floored hut while infant son Javan suckled and his twin brother napped nearby. With their birth in April, Juma now has six children, not an unusual number in western Kenya, where many women live in deeply traditional villages nestled in the hills rising from the rocky shores of Lake Victoria.

Juma's attempts at family planning were frustrated by a combination of poverty, limited access to birth control and medical problems that made it unsafe for her to use contraceptive pills or injections, she said.

The man who, in accordance with local tradition, inherited her after her husband died refused to use condoms, she said. And she lacked the means and the knowledge, she said, to travel to a regional hospital where she might have found access to IUDs, contraceptive implants or surgical sterilization -- all once staples of U.S.-funded family planning programs here.

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