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Giving women reason to hope

By starting an ambitious program in South Africa for HIV-positive mothers, Dr. Mitch Besser proves that one person can make a real difference.

June 24, 2005|Bettijane Levine | Times Staff Writer

NEW YORK — Babalwa Mbono wined, dined and traipsed around Manhattan as if she were accustomed to the kinds of places she went: a party in a millionaire's postmodern loft, the gleaming corporate headquarters of Johnson & Johnson, the well-appointed apartment she stayed in during her trip. In truth, she had never seen anything like them.

Her home in South Africa is a cardboard hut. She uses a communal outhouse, gets water from the streets or the town tap. Her village of Kyalitsha, just outside Cape Town, is ravaged by AIDS, as is most of her homeland. Her two young sons are among the 1 million babies born in South Africa each year to HIV-positive women, often contracting the virus at birth.

But Mbono is not the tragic figure one might expect from that thumbnail sketch. Articulate, intelligent, with a quick sense of humor, she recently traveled here on a fundraising mission led by the man she believes saved her life.

Mitch Besser, an obstetrician and gynecologist from San Diego, moved to Cape Town 4 1/2 years ago to try to help curb the raging AIDS epidemic that he says is "creating a nation of orphans" and eradicating a generation of mothers. He quickly found that medical expertise was useless unless women like Mbono were willing to take advantage of it. But they were terrified of even taking the HIV test, he says.

"The big issue is stigma," Besser explains. "Just taking the HIV test is a sign to your partner, your family, the community, that you might be at risk. To be perceived that way means you will be ostracized and abandoned by family and friends." Mbono amplifies: "If you have HIV," she says, "no one wants to be with you, talk with you, let you into their house. Even the boyfriend or husband who gave you the illness may push you out, with no way to get food, no place to live."

These psychological and social pressures are almost as daunting as the virus itself, both say. To help eliminate misinformation in a country with so little public health education, so few doctors and nurses, Besser's idea was to train the women themselves -- as educators, motivators, informed supporters of one another.

In his Mothers' Programmes, pregnant HIV-positive women are taught methods to prevent transmission of the virus from mother to child, before and after birth. They learn about medications, nutrition, formula feeding -- and how to combat societal pressures. Once their babies are born, they become mentors to the next group of newly diagnosed pregnant women.

The program started at one Cape Town maternity clinic three years ago and has since expanded to 64 sites across the country. Besser plans to extend it into Botswana, Ethiopia and Mozambique within the next three months, he says.

Most South African women are not even offered an HIV test until they become pregnant and go to a maternity clinic for an exam, Mbono says. By then the stakes are even higher: "If they test positive, they consider it a death sentence for them and their unborn child." Most believe their only option would be to "have an abortion or kill themselves," she says.

She has seen it all firsthand. Her sister committed suicide after being diagnosed positive at 18. "She just couldn't take the stress, couldn't take the virus within herself," Mbono says. Although the HIV virus is an equal-opportunity attacker, to Mbono it seems it is women who suffer the most humiliation and indignity. Now 30, she became pregnant with her second child three years ago. She took the test, quite certain she was healthy. She remembers exactly what happened next.

"The counselor tell me, 'Babalwa, you are positive.' I was so shocked. I just closed my eyes. I said, 'Tell me again.' " The counselor told her two more times, even showed her the form that read "positive" in heavy black ink. "I can't explain how I was feeling, so angry at everything. I tell myself, 'This is my husband that brought this to me. I am going to be sick and die. My baby is going to be infected and die. How am I going to leave my firstborn child, and he is still so young?' "

Mbono was more fortunate than her sister. The clinic where she tested had just started offering Besser's program. The counselor took her to the mentoring group, just a few steps away. She refused to look in. "I didn't want to see sick women and their dying babies," she says. But when she opened her eyes, she remembers being "shocked and relieved. Because I see happy people. I see healthy moms and their healthy children playing on the floor."

Mbono now believes that single act of joining the group has saved her life, certainly the life of the child she was carrying.

Exporting success

In California, Besser, 51, had a large private practice and headed the maternal HIV clinic at UC San Diego from 1990 to 1999, where, he says, there has not been a single case of mother-to-child transmission among clinic patients in the last 10 years. "If we could make it happen there, why not elsewhere?"

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