Harriet Birungi is a medical anthropologist and associate with the Population Council’s Reproductive Health program. As the director of the Population Council’s operations research projects in Kenya and Uganda, she promotes innovative ways to improve service delivery.
When I first met Annet, she was 17 years old, out of school, and living alone in a house left by her recently deceased mother. Annet came to The AIDS Support Organization (TASO) nearly every day to run errands for the TASO staff and to receive some food. Annet’s daily struggles are typical of HIV-positive adolescents who are poor and without a family to care for them.
In the first of several conversations, she complained about her experiences with AIDS medications. Side effects made her breasts and stomach significantly larger, she said. When I looked at her more closely, I realized that something else was going on; either she was trying to hide something from me or she wanted to say something more. I explained that I was not interested in talking about AIDS medications, but would rather discuss her life and relationships in general. She smiled and looked down, declining to say anything.
Two days later she opened up to me. She talked about her boyfriend, who had disappeared. She was upset that all her attempts to reach him had been unsuccessful. She asked if I could call him on my mobile phone. I agreed, only to discover that his number was out of service.
Annet looked desperate—she really wanted to tell me more. We got lunch, sat down, and ate together. During lunch she confided that she had had sex with her boyfriend and feared that she was about two months pregnant.
To my surprise, Annet had not discussed her pregnancy with the TASO counselors even though she had a good relationship with them. When I expressed concern, she begged me not to disclose her pregnancy. Later, she confided: "They love me so much. I am like their own child. By becoming pregnant I have disappointed them, and I may lose all the support I receive from them."
I offered Annet encouragement and asked if we could meet the following day. I made an appointment for her at a teen center where her identity would be kept confidential. During the prenatal exam, it became clear that Annet was in the seventh month of pregnancy, yet she had concealed this all along. She had not visited any prenatal care services or received any information on prevention of mother-to-child transmission of HIV. She had not made a birth plan.
Annet was lucky to have been identified through our project, but many pregnant HIV-positive adolescents remain invisible. We may never know how many young people there are like Annet who have unprotected sex, are pregnant, are considering having an unsafe abortion, are about to give birth without skilled medical assistance, or do not get services to prevent mother-to-child transmission of HIV. Without help, it is likely that they will have an HIV-positive infant. Each of these unfortunate scenarios is preventable. They each point to the urgent need for programs to reach a population that was never expected to survive, yet now these young people live well into adulthood to become parents.
Once Annet connected with the appropriate health care services, her situation changed dramatically. When she delivered her baby, a skilled birth attendant was there to assist her. After the birth, Annet received counseling on breastfeeding and how to prevent mother-to-child transmission of HIV. She also learned about contraceptive use during the postpartum period.
Two months after her baby’s birth, Annet called to inform me that her baby tested negative for HIV. This is the outcome desired for all pregnant young people living with HIV in Africa.