Meeting Mothers at the Center of Ecuador's HIV Prevention Efforts.

I have now been in Ecuador for two weeks on a trip made possible by the International Reporting Project. I have visited coffee and cacao farms, health projects, and sites of oil contamination. I have visited with NGO leaders and government ministers. This week, I managed to meet up with World Pulse member Diana, an inspiring role model for women in the tech sector, working for digital inclusion in Ecuador.

This journey—through mountains, rainforest, and the coast—has altered my sense of distance.

In the span of a 30 minute plane ride, it is possible to travel from Ecuador’s highland capital Quito to the Amazon oil industry outpost Lago Agrio, which feels like a world away. Or the same 30 minutes in a dusty crawl by van can take you to a farming community a few miles off the well-paved road, which is lined with palm plantations and rusty oil pipelines. Occasionally, the only available route from A to B involves a winding mountain pass or a motorized canoe.

Ecuador is roughly the area of the state of Oregon, where I live. And yet, there is such vertical drama in this terrain that if one could to take this small country and iron it out flat, the area would double.

This is why, as we toured a crowded ward in the Enrique Sotomayor maternity hospital in Guayaquil, I was not entirely surprised when a doctor told us that some women travel up to 16 hours to get here.

Monday, October 26th: innovations in ending Mother-to-Child HIV transmission

The Enrique Sotomayor hospital, located in Ecuador’s most populous city, was founded in 1948 and is one of the largest maternity hospitals in South America. Somewhere between 15% to 20% of all babies in Ecuador are born here. This is a private hospital, but the care is free (or donation-based for those who can pay). Modern amenities like an ICU and advanced equipment draw patients, and other hospitals transfer many of their most serious emergency cases here.

Our group of journalists is here to learn about a partnership between the maternity hospital and the VIHDA foundation, which is focused on HIV and AIDS. This partnership has stemmed the rates of mother-to-child transmission of HIV in Ecuador—a crucial front in the struggle to stop the spread of the virus.

UNAIDS now estimates roughly 41,000 annual new cases of HIV in Ecuador (up from 10,000 when VIHDA began the program in 2006). VIHDA extrapolates a higher number from its own data: 75,000 annual cases. This would represent a .5% national infection rate, or one out of every 200 adults. And the disease is increasingly feminized. Power differentials between men and women can contribute to the spread of HIV. Nora, a patient in the VIHDA program, says that although she suspected the partner she believes infected her with the virus of infidelity, he would never have listened to her if she had asked him to use a condom. The ratio of HIV positive men to women in Ecuador was once 10:1. Today it is 1.5:1

Claudia, the psychologist for the VIHDA program, leads us through the hospital’s complex maze of corridors. Occasionally our small group will stop to observe, shuffling positions to avoid blocking the traffic flow of healthcare providers, patients, and visiting families. We learn that the hospital has gradually annexed neighboring buildings in a steady expansion. We turn a corner, and a hallway opens into an outdoor passageway. We walk past nurses carting gurneys, ascend some stairs, and just as suddenly, we are delivered back indoors. A new, larger facility is currently in the works, but for now, the practitioners appear focused on immediate concerns.

There are frantic calls to make to neighboring countries to cover impending shortages in government-supplied injectable antiretroviral medications. There are vials of blood samples in the lab waiting to be tested for the HIV virus. And there are the urgent needs of patients, dozens of them with babies in tow, squeezed in a waiting room that opens out to the street.

Here, women wait to meet with the handful of hospital counselors and social workers, including our tour guide Claudia. She is the sole psychologist in the VIHDA program, which provides four free counseling sessions a year for life to every HIV positive mother in the program. Although Claudia is not taking patients until later in the afternoon, women are already lining up to meet with her.

“This is cultural,” Claudia says. The women have appointment slots, but they still show up early. Andrea, one of Claudia’s clients, smiles broadly as she introduces her 9-month old daughter, who is HIV negative. The daughter plays with my notebook as her mother tells us what this program has meant to her: food for her children, help when she needs it, and a lightened burden. She no longer fears that she or her children will get sick.

Among mothers whose HIV status was known at the time she gave birth and who received treatment in the VIHDA program, there has only been a single case in which the child contracted the virus. In the absence of any intervention, mother-to-child transmission rates can be as high as 45%.

The primary focus of our visit with VIHDA is to learn about the innovation of single-serving easy-to-administer sachets of antiretroviral medication, which have led to safer and more effective treatment of infants. However, this mechanical solution is only one ingredient of the program’s success.

Claudia’s work as a psychologist is equally vital. Humberto Mata, VIHDA’s charismatic founder, says that in Ecuador, the stigma of HIV can be as deadly as the virus itself. Shame and societal rejection can lead to a sense of powerlessness and a lack of will to follow through with treatment. Through counseling, VIHDA is attempting to give women more power, to rebuild their confidence and a sense of control over their lives.

Maria, a client living with HIV, lost her job and was forced out of her community when she was diagnosed. Her family abandoned her, even conducting a funeral for her. Today, Maria feels healthy. With treatment, she now compares her HIV infection to something as benign as the flu. But her family treats her as if she is already dead. Years after diagnosis, the mention of Maria’s family draws fresh tears. She struggles with isolation and with making ends meet, but she follows the daily HIV regimen religiously and all of her children are currently free of the HIV virus. As she speaks with us, Maria’s one-year-old son sleeps peacefully in her arms. Her dreams for herself and her children are very much alive.

VIHDA holds a graduation ceremony for babies when they reach the milestone of 18 months free of HIV. The mothers are acknowledged for their strict adherence to treatment plans and their dedication to keeping their children healthy. This is the kind of support Maria is referring to when she calls the VIHDA program her second family.

Like Maria, Nora was also ostracized in her community after her HIV diagnosis. Although she would like to move and start anew, she feels her children and finances are holding her in place. Now, however, she has a support system to help her cope with discrimination. Rather than breaking her, she says her diagnosis has made her a more compassionate person. She can’t stop the gossip or the stares that come her way. But she says she now holds her head up when she walks through town.

Sacred stories

I feel incredibly humbled after meeting women like Maria and Nora, who have opened their hearts and shared some of their most personal fears and hopes with me. People here have been so open with their lives and with their stories. I am now headed back to the Amazon region, and when I next have Internet connectivity, I will share more of the stories that have been so generously shared with me.