It is a partly cloudy day at Taga farm, ward 15, Seke district, and there are eight women and two men who have gathered for their weekly meeting at a community antiretroviral treatment refill group (CARG).
The group formed about two years ago brings together people living with HIV and Aids and are on ART.
Part of the group is a couple who are proud parents to three beautiful children aged six months, three years and five years.
What is unique about this couple is that they are both HIV-positive, but they have managed to have three HIV-negative children.
HIV is transmitted in only three ways: through unprotected sexual intercourse, heterosexual or homosexual; through blood or blood products, donated semen or organs; or from an infected mother to her child (vertical or mother-to-child transmission). More than 70% of infections are a result of heterosexual transmission and over 90% of infections in children result from mother-to-child transmission.
Life for the couple, Claudio Hanyiwa (55) and his wife Chipo Makuvire (42), did not end back around 2011 when they were both initiated on ART, rather they have lived better days and are now proud parents of three healthy children.
While HIV and pregnancy is not a topic we hear a lot about in Zimbabwe, the incredible success of ART means most Zimbabweans diagnosed with HIV assume a long and healthy life, along with the milestones of sex, relationships and family.
The well-managed use of ART means mother-to-child transmission of HIV is now controlled in the country.
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For a person living with HIV like Makuvire, however, achieving a pregnancy is not without its complications. She said condoms are central to safe sex — the main protection against transmission of HIV — but of course condoms also protect against pregnancy. For heterosexual people in a sero-discordant relationship (where one person is HIV-positive, the other HIV-negative), options for conceiving children have tended to be either expensive or risky. At the expensive end are fertility treatments, such as sperm washing and in vitro fertilisation.
At the riskier end, many couples take a chance on sex without a condom. If the HIV-positive partner is on ART and the virus has been suppressed in their system, then recent studies suggest this can be a relatively safe option.
Hanyiwa and his wife have been fortunate to have access to pre-exposure prophylaxis (PrEP) — a course of a combination ART drug called Truvada that she took to prevent their children from becoming infected.
Research has so far shown that, taken correctly, PrEP significantly reduces a person’s chance of acquiring HIV. PrEP has been described as a sexual game changer: a pill that re- introduces the possibility of “safe” sex without condoms.
While others have argued that PrEP provides licence to be irresponsible, undermining years of effort to legitimise condom use and risking an increase in rates of other sexually transmitted infections, PrEP has more supporters than critics.
While it might not offer a global solution to stopping HIV, it certainly presents an effective prevention option for people at high risk of acquiring HIV.
For sero-discordant couples wanting to conceive children, PrEP is undoubtedly a game-changer, allowing natural conception with minimal risk.
The existence of Gracious (six months),Liberty (3 years) and Tanaka (five years) is clear evidence to support the safety and efficacy of PrEP for couples trying to conceive.
“We were both initiated on ART around 2011. You know at first I was in denial, but with my wife by my side we managed to support each other and today we have three children who are all HIV-negative,” said Hanyiwa.
“So, all things are possible these days now we have organisations like the National Aids Council [NAC] and its implementing partners who are rolling out different programmes in response to HIV and Aids in the country.”
He said joining the refill group had also assisted him and his family live a health lives.
“I am one of the two men in this refill group around here. In 2011, I was initiated on ART and accepted my condition. Look now I am very fit, I am very well. I also encourage other men to go for testing so that they know their status. Knowing one’s status promotes a healthy lifestyle.”
But people living with HIV and their partners still encounter stigma if they decide to have children.
Makuvire said there are people in society who look down upon people living with HIV and Aids and are on ART.
“As you can see, I am breastfeeding and I was told that it is safe for about a year. I am happy that we are living positively. We are grateful to this NAC-initiated refill group which is helping us fight stigma. With this group, we send one member to collect or ART and that saves us money and time. At the same time we don’t all go and crowd health institutions,” Makuvire said.
The chairperson of the CARG Violet Nyamande said they were a self-forming group for people living with HIV who are on ART.
“The group assists us to reduce costs of going to collect medication. One person goes with all our cards once after three months or so,” Nyamande said.
“Members to benefit should not be pregnant because such people require constant checkups at the hospital. One should be over 15 years and should not have TB or other opportunistic diseases which also require constant checking with health experts.
“So, this group has created a bond and we put each other to task for continuous intake of ART. We now have income-generating projects because of the bond we have.”
NAC Seke district Aids coordinator Florence Nyandoro said there were about 20 CARGs in the Beatrice farming community.
“These groups are working wonders as they are assisting members save money and make money through projects. There are low cases of defaulting because they advise each other, we check on each other and do pill count to ensure continued taking of the ART drugs and so it is one way of curbing defaulting on ART,” she said.
The number of people acquiring HIV each year is falling in Zimbabwe, although levels are still relatively high. In 2017, there were 41 000 new infections, compared to 73 000 in 2010.
