VietNamNet Bridge – Sitting alone on a bench outside the Obstetrics Department of Thot Not District General Hospital in southern Can Tho City, the round and sun-bronzed face of a young woman betrays a gnawing anxiety. Her eyes sometimes flit down to her soil-filled finger nails which cling tightly to the bench. Her threadbare hat tumbles to the floor but she does not care about picking it up.

She seems to be on the brink of a life-changing event.

As department deputy head Nguyen Ngoc Diem Uyen's door opens, the woman rushes towards it. Dr Uyen hands her a result paper and says: "The results of the HIV PCR test show that despite being exposed to HIV, your baby has not contracted the disease. Go home and celebrate this huge slice of luck."

The troubled woman, 27-year-old Nguyen Le Chin (not her real name), is one of more than 12,760 pregnant females in the city who have been tested for HIV this year. Furthermore, she is one of the 24 unfortunate women found to be HIV positive by these tests. Fortunately, she was provided with expert consultancy and treatment to prevent the virus from being transmitted to her unborn child.

Lai Kim Anh, director of the city's HIV/AIDS Combat and Prevention Centre says these tested cases account for more than 85 per cent of total pregnancies in Can Tho City this year. The mother-to-child transmission prevention project, which started in the city four years ago, has reduced instances of mother-to-child HIV transmission to zero this year, down from nearly 12 per cent in 2008.

Meanwhile, the national target programme has set a goal of bringing mother-to-child transmissions under the 5 per cent mark by 2015, she says.

If this prevention process was only implemented in obstetrics hospitals, it would be useless, she says. It needs to include early HIV tests at commune-level healthcare clinics, while pregnant women must receive regular health checks and vaccinations.

Chin's story

Having pottered about the paddy fields tending ducks since she was small, Chin had never gone to school or even left her village. When she was 24 years old, she was introduced to a man and told that he would become her husband.

"I did not have any feelings for him. I merely accepted because the matchmaker told me he was kind and trustful."
Chin soon fell pregant, but it took the young girl three months to realise.

She says during her first pregnancy check, the doctor at her commune's health clinic extracted some of her blood to detect whether she had any serious diseases.

"At that time, I laughed because I was so strong that no disease could possibly exist in my body."

However, one week later, she was asked to come back by the doctor and was then told she had contracted HIV. He instructed her to go to the district's general hospital for more checks and a consultancy next day.

"I did not know what HIV was but one person in my village had died of it. So, I knew it must be a terrible killer and feared that my foetus would suffer the same fate as me. I was also scared that I would transmit the virus to others if I had any interaction with them."

Chin was deeply saddened but shed no tears. "It seems a life with paddy fields and ducks has made me unable to express my feelings."

She kept quiet about her disease because people in her village and family were scared of the virus. She wandered around the field for a whole day and agonised about whether to have an abortion.

But everything changed for the better when she met Dr Uyen at the district hospital and she was soon undergoing treatment.

Dr Uyen says like other pregnant women who are HIV positive, Chin was asked to take AZT (also called Zidovudine or ZDV), a kind of anti-retroviral medicine taken at 14 to 34 weeks of pregnancy, to lower her viral load (the amount of HIV in her blood).

"When her viral load is very low, it is less likely that she will pass HIV to her baby, so this is her best chance."

Dr Uyen was Chin's only companion during her hour of need. Even her husband, the only person she told about the disease, failed to show any care.

"He coldly told me that the worst consequence was death, so there was nothing to worry about and that he was too busy to visit me," she said.

Chin asked him several times to take a HIV test but "he refused and said he did not believe doctors, their stupid drugs and even the disease they were talking about."

"He acted as if it was nothing to do with him. I have spent my life in the fields with ducks, so there is no way I could contract this disease. It is him that brought this terrible affliction to me."

Lucky baby

When she was going into labour, Chin also got some ARVs to reduce the risk of infecting her baby during the process. Chin's baby was born weighing 2.9kg and received special safety and hygiene measures for the first four weeks of her life to counteract exposure to the virus during labour.

She is growing up as all babies do and receives regular health checks. She will also be provided with free milk until she is 18-month-old - babies can be infected through breastfeeding so Chin was asked to bottle feed her baby only.

And much to Chin's relief, the four-week-old baby has undergone a HIV PCR test indicating she is free of the virus.
Dr Uyen says: "The PCR test is very important. It can tell to 98 per cent certainty whether or not a baby who is HIV-exposed has contracted HIV."

Chin's baby is a lucky case as she was treated from an early stage. According to Bui Duc Duong, deputy director of the Viet Nam Administration of HIV/AIDS Control, in many localities, the number of pregnant women getting HIV tests and consultancy falls between just 6-30 per cent of total pregnancies.

The statistics show that without proper treatment, the risk of a baby contracting HIV from their infected mother is between 35-40 per cent. This means more than 1,820 babies will contract HIV every year in Viet Nam.

Meanwhile, Chin is looking forward to when her child is 18 months old and will undergo the second test which tells with certainty whether her baby is in the clear.

Chin is still using ARVs as usual and suffers no side-effects. When she suffers headaches or sickness, Dr Uyen is always her first port of call.

Now, despite earning just VND60,000 (US$2.5) each day, Chin has started saving money for when her daughter goes to school. She holds a strong belief that she will live as long as HIV-free people so long as she uses ARVs according to the doctor's advice.

"Like ducks, which have to wade through water to follow their flocks although they are sick, I and my child can survive in spite of our difficulties."

VietNamNet/VNS