At a local maternity clinic in one of Bulawayo’s high density suburbs, midwives are at pains to explain to a pregnant 15-year-old girl why she must be tested for HIV before she gives birth. But the teenager, who lightly beats her chest in an effort to pacify what seems like a painful cough, will not hear of it. She is afraid that her worst fears will be confirmed as she already suspects she could be HIV-positive. The nurses are worried about the teenager’s health and decide to call in the girl's grandmother who is given the task of explaining to the teenager why she must be tested. Getting tested is the only way she will be prescribed the medication that will not only treat her cough, but also give her longer life to see her unborn child grow up, the grandmother assures her. Only then does the HIV test go ahead. It is a scene Nontando Siziba, a 53-year old midwife, has seen many times. Though she does not provide ready figures, Siziba says rather bleakly this is not an isolated case as a growing number of pregnant young girls are visiting the maternity clinic. Siziba explains that some young mothers are still unwilling – and afraid - to access antenatal health care under the prevention of mother-to-child transmission (PMTCT) program-me. "We now test all pregnant women for HIV as part of attempts to protect the health of both the mother and child but this is sometimes very difficult when we are working with teenagers," Siziba explained. A 2002 ministry of health and child welfare national antenatal surveillance found attendance at antenatal program-me was 25.7 percent, with the ministry noting that this increased the transmission of the HIV virus to infants when proper antenatal health care could have avoided this. There are also concerns among HIV/AIDS activists about the early initiation of young girls as thirteen – are forced into sexual activity. This is being blamed on gender power dynamics where older men are in total control of sexual relationships and tend to decide whether they have protect or unprotected sex. Experts say the circumstances of these adolescents are also being exacerbated by the non-utilization of PMTCT programmes especially among teenagers who seek antenatal health services. Siziba says this has also been fed by the continued HIV/AIDS stigma among sexually active teenagers who, she says, feel isolated by the perceived public knowledge that they are not only sexually active but also HIV-positive. "Though they are sexually active, not all are willing to take the responsibility to take precautions," Siziba said. "We have had cases where these young people are told not to breastfeed but do so anyway saying if members of the community know they are not breastfeeding their child then they will know they are living with the virus. It has become that frustrating." The Regional Psychosocial Support Initiative (REPSSI) recently issued a report where researchers noted with concern that many young mothers only discover they are HIV-positive when they are pregnant, and sometimes only learn their status when their children fall ill. REPSSI is an NGO that works toward the psychosocial care, support and well being of children affected by HIV/AIDS in East and Southern Africa. "We feel there are gaps around psychosocial care and support for adolescents," said Brighton Gwezera, REPSSI Knowledge Development and Exchange Manager. "They (adolescents) are still failing to handle issues relating to stigma and this has seen them failing to fully benefit from antenatal health care." The interaction of adolescents living with HIV has been identified as one of ways that seeks to demystify the link between pregnancy and HIV, ironically in an age where young people are bombarded each day by a deluge of information. "What we are doing is working with adolescents living with HIV through support groups so they can easily communicate their concerns and decisions surrounding being HIV and pregnant and also their future," Gwezera said. There are also concerns about cultural considerations that have denied adolescents access to both formal and informal support, which researchers say is hindering efforts to provide relevant reproductive health assistance. "The fact that they are pregnant marks them out as sexually active which itself carries its own stigma. So when you throw in being HIV-positive, these young people would rather keep this to themselves," said Jerome Siyasiya a youth counselor with the Roman Catholic Church’s Sibambene AIDS Trust. He adds that this is a time when young mothers need support the most. Gwezera agrees: "There is little information getting to adolescents about HIV and pregnancy that is why we see resistance in accessing proper antenatal health care. What needs to be done is the setting up of more support groups for young people where they can freely discuss issues relating to their circumstances." With the poor understanding of HIV/Aids and its relation to antenatal care, it could be time before adolescents and other young people fully embrace antiretroviral therapy as the country moves toward the implementation of the health for all ideal. "Young girls fail to utilize protection against HIV, now they are failing to protect their unborn children. I do not want to believe we are losing this fight," said Siziba. Source: Ignatius Banda/IPSNEWS.NET