Bloodborne HIV: Don't Get Stuck!

Come 2015 a lot of people will still be flailing about looking for scapegoats to explain their country’s falling short of various Millennium Development Goals. But one group of scapegoats must be well accustomed to having the finger pointed at them; traditional birth attendants (TBA). In an article from Uganda appearing on AllAfrica.com, TBAs are being “blamed for HIV among newborn babies”.

Is the finger of blame being pointed at them on the basis of research this time, or is it the usual politico/journalistic reflex? The sheer vagueness of the article suggests that it is based on the latter. What self-respecting politician or journalist would read research, anyhow? No checkable source is cited, though that’s nothing unusual for AllAfrica.com; and one of the people cited says “there are many deaths and new HIV infections among new babies that go undocumented and […] the statistics may be falling short of the exact number”.

If some of the new infections among babies are documented, why are they not also investigated? Are the mothers HIV positive? Or are some of the mothers HIV negative? HIV negative mothers with HIV positive babies are not uncommon, but investigations into this phenomenon in African countries is very rare indeed.

An obvious question for politicians, journalists and others who wish to indulge in the perennial practice of blaming people, whether they be TBAs, men who have sex with men, women, foreigners, truckers or whoever else, is why HIV prevalence tends to be a lot higher in areas where people have better access to health facilities. TBAs tend to be more common in isolated and rural areas, where HIV prevalence is generally a lot lower.

The suggestion is that TBAs are not able to protect babies of HIV positive mothers from being infected, whereas qualified health personnel may be able to prvent mother to child transmission. True as this may be, how are TBAs supposed to be able to resolve this problem themselves? If it is the case that about half of all deliveries are overseen by TBAs, rather than conventional health personnel, this is hardly the fault of TBAs. They are not drawing big salaries, nor are they receiving thorough training or any other incentives for their work.

There are severe shortages of skilled health personnel in Ugandan health facilities. The facilities are stretched beyond their limits already. Is the government going to import enough doctors, nurses and others to fill the 50-60% shortfall that many facilities are experiencing? And more importantly, if the health facilities are going to be even more oversubscribed than they currently are, how safe will they be then? They are not currently safe places to give birth and some health figures show that those attending health facilities could be at higher risk of being infected with HIV.

Before blaming TBAs, it would be a good idea to carry out some research to find out exactly how so many babies are being infected with HIV, and how many have HIV negative mothers. Once that is clear, Uganda will be in a position to figure out what to do next, though it remains to be seen whether the country will be provided with the means to do anything effective. Donors are often keen on providing various health services for high profile, newsworthy conditions, but they are a lot less enthusiastic when it comes to ensuring that health services are safe.