A ray of hope

Matthew, a bright alert baby of four and a half months, is practising his elbow jabs. “Are you going to be a boxer?” Jennifer Ngcobo* coos. She tends to him with the absorption of a besotted first-time mother.
Gently pulling up the socks he tries to kick off. And frequently, almost obsessively, pulling down his lower lip to examine the spots in his mouth.

Ngcobo is not just worried about thrush. She found out six months into her pregnancy that she was carrying the HI virus. Matthew is the first of 34 babies born in the Knysna hospital to HIV-positive mothers since mid-January. This was when Knysna became one of 18 pilot sites of the Department of Health’s programme to prevent mother-to-child transmission of HIV. The programme involves counselling at every stage and includes a voluntary HIV test, giving the mother one nevirapine tablet to take during labour (which temporarily reduces the mother’s viral load), and administering a teaspoon of nevirapine syrup to the baby within three days of birth (to reduce the HIV that might be present in the baby’s blood).

But it was Ngcobo herself who made the effort to obtain nevirapine before her baby’s birth. Late in December, just three weeks before her due date, she heard a radio report on the anti-retroviral. In the first week of January all municipal clinics were still closed for the end-of-year holidays, so Ngcobo repeatedly badgered Knysna pharmacies (who said they could only order the drugs in bulk) and a private doctor, until a pharmacist established that nevirapine was available at George hospital 40km away.

The next day Ngcobo and her mother caught a taxi to George. They met the hospital pharmacist who sent Ngcobo upstairs to the maternity ward. She told her story again and the nursing staff suggested she give birth in George. Ngcobo insisted she lived too far away to make this feasible, and they agreed to send the nevirapine for Ngcobo and her baby to the Knysna hospital.

Finally at peace, Ngcobo and her mother took another taxi home to wait for the first signs of labour.

Two weeks later she admitted herself to the Knysna hospital with severe contractions. When she was in the middle stages of labour she took her nevirapine tablet. But labour did not proceed normally, in spite of being induced and a night of intense pain, and she was given an emergency caesarian section under a general anaesthetic early the following morning.

“When I woke up in the hospital ward the first thing I was looking for my baby,” she recalls. “The nurses told me he was at the nursery. The next thing I worried about was giving him the nevirapine. They said no, they did give him the syrup.”

Then they brought her son to her. “I saw him and thought: I like him, I’ll take him,” she laughs. “He was sleeping, I woke him up and he looked at me.”

Ngcobo benefits from the free post-birth section of the mother-to-child transmission programme: she sees her counsellor each time she visits the antenatal clinic. As she chose to bottle feed (in order to avoid the 5% risk of transmitting the virus through breast milk), the clinic gives her two tins of formula milk each week. With electricity and a fridge in the house she shares with her mother and grandmother, Ngcobo is able to ensure the bottles are kept sterile. She keeps boiled water in a flask and makes up one small bottle at a time. And since Matthew turned six weeks old, the clinic sisters have issued Ngcobo an antibiotic to give her baby three times a week to prevent infection, in particular the strains of pneumonia associated with Aids.

At the age of nine months Matthew will be tested for HIV for the first time. If he is found to be negative, all Ngcobo’s efforts will be rewarded. If he tests positive, this could simply mean he is still carrying his mother’s HIV antibodies. He would then be tested again at 18 months.

Statistically, Ngcobo fits the profile of many HIV-postive mothers in the area. She is in her 20s, unmarried, and lives in one of the informal settlements overlooking Knysna and its famous lagoon.

But Ngcobo could never be considered a victim. She is full of energy and optimism. She obtained a matric in physics (her favourite subject), maths, biology, Zulu, Afrikaans and English. And in a town where unemployment levels are dauntingly high, Ngcobo established a career for herself in the food industry. She was production chef at a top beach hotel when she fell pregnant. Since Matthew’s birth she has operated an informal telephone booth. She hopes to soon secure a job where she can use her driver’s license.

Perhaps Ngcobo’s close relationship with her mother (her parents are divorced) is her greatest asset these days. “My mother is too close to me, I tell her everything. So I told her right after I had the test,” she recalls. “I was so shocked when I heard I have HIV. My mother was disappointed. She asked how did you get it. I told her I only have one partner and she knows him. She didn’t get angry.”

Matthew’s father lives in a nearby Klein Karoo town where he owns a fleet of mini-bus taxis. He has two older children who live with his family in Johannesburg. She describes him as “tall, dark and too much of a talker”. He was her second boyfriend. Although they never lived in the same town, they saw each other whenever they could.

Ngcobo has not seen him since she obtained the results of her HIV test. “I was angry with him. When he called I said I’m not feeling well, so I’m not coming to see you. We still phone each other and if I need something for the baby he sends me money.”

Ngcobo has not told him of her HIV status, and is anxious about doing so. “I want him to know but I don’t know how to tell him. Virginia, my counsellor, says I must ask him if we can both go and get tested. And then when he gets the result we can discuss it.” But she is not sure. Nor is she ready to join a Knysna support group for HIV-positive people.

With her zest for life and know-ledge of nutrition (“My granny is diabetic, so we are very careful about eating healthily”), Ngcobo is instinctively following the tenets of “living positively” with HIV/Aids.

In the meantime, every spot in her son’s mouth weighs heavily on her. “I will just be happy if Matthew doesn’t have the virus. It happened to me but not to him. Oh my God, I don’t want it to happen to him. I don’t want to think about it too much. When he tests negative, I’ll be glad.”

* Not her real name

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