‘I don't want my boy to be positive': pregnant women face sky-high viral loads as cuts hit HIV care in Africa

Aphelele Mafilika was born HIV positive in 2004. Put on antiretrovirals (ARVs) as a baby, she has been on the life-saving medication ever since and has lived a normal life. No longer. 'Now, I have a problem,' she says.
For most of her life her viral load (the amount of HIV in her blood) has been undetectable. 'When I went for my February clinic visit, I didn't get my pills. They told me 'shortage of staff' and 'come back another day'. I came back a few times, but it was the same story.'
Mafilika, who is seven months pregnant, took no ARVs in March or April. She finally managed to get a batch in mid-May but by then her viral load was sky high. 'It has never been high like this,' she says. 'It is too risky for my unborn baby.' The risk of transmitting the virus to her child during delivery or while breastfeeding is much higher if her HIV is detectable.
'My fear is that I will get sick more, I will get other infections like TB. And my fear for my baby is too big,' she adds. 'I don't want my boy to be positive.'
Mafilika knows first-hand the mental struggles of growing up with HIV: 'At school they teased me,' she says. 'They would say, 'You are positive … Why are you always going to the clinic? Why are you eating pills?''
Sister Sibongile Mqaba, who has worked in the same clinic in Cape Town for 32 years, is hopeful that Mafilika will get her viral load down before she delivers. But Mafilika is not the only patient struggling to get treatment since the suspension of most Pepfar (President's Emergency Plan for Aids Relief) funding to South Africa. Since initial cuts in January, US president Donald Trump has made further significant reductions.
South Africa's health minister, Aaron Motsoaledi, has complicated matters by insisting that the country's HIV programme is 'not collapsing' and assuring the public that there is no shortage of ARVs.
While it appears US funding cuts have not significantly dented ARV supply, Mafilika's story illustrates that access to treatment is about more than pharmaceutical supply. The abrupt stop-work order issued to Anova Health Institute, the largest recipient of Pepfar funding in South Africa, on 25 January meant that her local clinic didn't have sufficient staff to meet patient demand on the days she visited.
It is not all about ARVs and Pepfar funding, either. Since 2016, Dr Dvora Joseph Davey, a US epidemiologist based in South Africa, has implemented several studies in government clinics in the Klipfontein area of Cape Town, all funded by the US National Institutes of Health (NIH). One study established that PrEP (pre-exposure prophylaxis, medication taken by HIV-negative people to prevent them acquiring HIV during sex) was safe for use by pregnant and breastfeeding women – a global first. Another study, called Scope-PP, which began in 2023, sought to optimise the rollout of PrEP in eight maternity clinics across Cape Town.
On 1 May, Davey was informed that her NIH funding could no longer be given to foreign sub-awards or collaborators outside the US. Friday 30 May was the study's last day.
The 18 women who were directly employed by the University of Cape Town as counsellors, interviewers, nurses, trainers and data collectors have all lost their jobs. The same is true for at least half of the 224 health workers around Cape Town who Davey's team had trained to provide PrEP for pregnant and breastfeeding women. 'Effective use of PrEP is about far more than simply taking a daily pill,' says Davey. 'Counselling, testing and support are all just as important.'
As an associate professor at the University of California, Los Angeles (UCLA), Davey receives funding awards from the NIH. For the past decade she has collaborated with the University of Cape Town via sub-awards, but the Trump administration has put a stop to this. 'I have over $300,000 [£222,000] granted to me via UCLA that I cannot get into South Africa,' she says.
It's a similar story across the country: a Médecins Sans Frontières report shows that in South Africa alone Trump's funding cuts have put at least 27 HIV trials and 20 TB trials at risk.
South Africa is possibly the most important place in the world for HIV research. Not only does it have more people living with HIV than any other country, but it also has world-class medical infrastructure. 'We can do meaningful research in a small community with 1,000 participants,' says Davey. 'To achieve the same outcomes in the US we would need 100,000 participants and millions and millions of dollars.' Recent analysis shows that every $1 of NIH funding generates approximately $2.56 of economic activity.
Then there is the impact on participants' lives. In the absence of intervention, the rate of mother-to-child transmission of HIV during birth and while breastfeeding can range from 15 to 45%. With the inclusion of antiretroviral drugs during and after pregnancy the rate is less than 2%.
South Africa had achieved a significant reduction in mother-to-child HIV transmission, with the rate dropping to 2.6% in 2024 from almost 15% in 2008. 'We were well on track to eliminate infant HIV,' says Davey. 'But without PrEP, ART [antiretroviral treatment] and other interventions, we will see rates of mother-to-child transmission increase.'
One study of 50,461 infants born to HIV-positive mothers in the Western Cape, where Cape Town is located, found that among pregnant women with elevated viral load (not on ART, or recently acquired HIV), 18% of infants were born with HIV. 'We don't want to go back to those days,' Davey says.
In all of 2024, three babies were born with HIV in the clinics in Davey's study. In the first five months of this year, even before cuts have fully taken effect, there have already been three cases.
What's more, 'closing these trials early violates the ethical standards we work by', says Davey. 'When a patient starts in the study, we promise to provide treatment and counselling until the end of the study. We've had to stop our study early and transition people back to the clinic to get their PrEP. And often the clinic doesn't have the nurses and counsellors or the PrEP.'
One such patient is Vuyisile Ndungane. She came to the clinic in 2024 during her second pregnancy and was told about PrEP by Lindelwa Dube, a counsellor trained by Davey. 'The moment Lindelwa introduced me to PrEP, I decided to use it till I gave birth,' says Ndungane. 'She helped me so much.'
As part of the study, Ndungane was given counselling about the importance of knowing her partner's HIV status and given oral HIV self-tests. 'When my baby was four months old, I asked my husband to test,' she says. 'He was happy to test, he wanted us to help each other.'
His test came back positive.
'He was sad and surprised and angry,' says Ndungane. 'In the beginning I was not OK. I wanted to know the truth. He eventually told me he was busy in the time when I was pregnant. He did not specify exactly, but he became transparent.'
Dube helped Ndungane through this crisis, coaching her on how best to handle the situation and encouraging her and her husband to come into the clinic for counselling. 'Most men don't want to go to the clinic,' says Ndungane. 'But the moment he got the counselling from them he realised … 'I did something wrong … I have to put my family first.''
He is now on ARVs and his viral load is undetectable.
'Now, I am fine,' says Ndungane, who is still HIV negative. 'But without PrEP I would not be fine. I don't want to lie.'
Ndungane only heard about the PrEP study's imminent closure on the day the Guardian spoke to her. She remains hopeful that she and her husband will be able to get their medications 'for ever'.
Sister Mqaba, who will be losing her job at the end of June, does not share the same optimism. 'My fear is mortality is going to be very high,' she says. Mqaba knows what an uncontrolled epidemic looks like, having lived through the late 1990s and early 2000s, when infections were rife and no treatment was available. (Even after ART had been developed and used in the global north, South Africa's president then, Thabo Mbeki, refused to provide it through the state health system.)
'In the bad days, you could diagnose people just by looking at them,' says Mqaba.
'They looked so sick. Now you don't see that. But we are going to go back there. We are going to see mothers dying again, when they are pregnant or when they have just given birth. We are going to see babies born HIV positive.'

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BBC News

20 hours ago

• BBC News

Top 10 health benefits of beetroot according to sabi pipo

Sabi pipo say one of di powers of beetroot na say e dey rich in nitrates. Wen we digest food or drink wey dey rich in nitrate, nitric oxide dey dey produced, wey dey known to cause di blood vessels to widen. Sabi pipo believe say dis fit lead to some health benefits. One study find say a daily dose of beetroot juice fit get a significant effect on blood pressure. Di study find say just a few weeks of eating some beets a day lead to a fall in average blood pressure of about 5 millimetres of mercury, if maintained, e dey enough to reduce di risk of stroke and heart attack by 10% . Studies don also find say beetroot fit get effect on blood pressure within a few hours of intake. Prof Andy Jones, Professor of Applied Physiology from di University of Exeter wey spend years investigating di effects of beetroot on sport performance explain how di nitrates inside beetroot improve dey improve di blood flow to our lungs and muscles, resulting in a faster delivery of oxygen. "Di potential dey for di muscle to dey receive more oxygen and to distribute dat oxygen within imsef more effectively because of di effects of nitric oxide", e tok. Not only dis, dem dey help you make more efficient use of oxygen during exercise, so you fit work harder, without feeling di strain. Wetin be beetroot? E belong to di same family as chard and spinach, pesin fit eat both di leaves and root of beetroot fit dey eaten – di leaves get bitter taste whereas di root dey sweet. Although dem dey available all year round, beets dey di sweetest and most tender during dia peak season, wey for kontri like UK na from June to October. While varieties like white and yellow beets dey make pretty dishes, only red beets get cancer-fighting compound betacyanin. How much I fit dey eat? Prof Jones bin advise say two-three medium beetroots, or one shot of beetroot juice, na all you need to see positive effects. Getting about 6 to 10 millimoles of nitrate a day na wetin dey important. E advise to dey keep steady intake of nitrates every day and every week for long term benefit. Researchers from Barts and The London School of Medicine and Dentistry say to drink one cup of beetroot juice fit lower blood pressure. "If you dey drink 250ml (8oz) e go cut high blood pressure readings by 10mm of mercury (mmHg)." One study of 15 patients, bring some into di normal range, di journal Hypertension, external bin report. Afta three to six hours, dem detect di effect one day later. But di researchers, from Barts and The London School of Medicine and Dentistry, wey study beetroot blood pressure lowering effects for years, also warn say more work still dey needed. And dem warn say to dey drink beetroot juice fit get one unexpected consequence - e fit turn your urine pink. Nitrate dey naturally inside soil, wia big vegetables dey take am in through roots to help dem grow. Researcher Dr Amrita Ahluwalia tok: "We dey surprised by how little nitrate dey needed to see dat kind large effect. "Our hope na say to increase one intake of vegetables wit high dietary nitrate content, like green leafy vegetables or beetroot, fit be lifestyle approach wey pesin fit easily employ to improve cardiovascular health." Prof Peter Weissberg, medical director for di British Heart Foundation, wey bin fund di research, tok say: "e dey support current advice say make we all dey eat plenty of green vegetables. "But we need larger studies in patients to determine if nitrate-rich vegetables dey effective to lower blood pressure over di long term." Also, di nitrates dey water-soluble though, so you need dey careful wen you dey boiling beets. To boil your beets go allow nitrates to come out into di cooking liquid, so you no go get as many benefits. Sabi pipo say if you really wan get di most out of dis vegetable e fit be best to buy am raw and bake am, or drink di juice! Top 10 health benefits of beetroot 1. E dey rich in protective antioxidants Red beetroots dey ranked as one of di 10 most potent antioxidant vegetables. Dis mean say dem dey help di body combat di damaging effects of di process weyndem call oxidation. Di plant compounds wey dey responsible for di root purple-crimson colour, anthocyanins, don show to get high anti-oxidant and anti-inflammatory capabilities. 2. E fit get anti-cancer properties. Betacyanin, di powerful plant pigment wey dey give beetroot im rich colour, also dey help suppress di development of some types of cancer, including bladder cancer. Beetroot contain oda potential cancer-fighting compounds including ferric acid, ruin and kaempferol. 3. E fit get anti-inflammatory properties. Some research suggests say betalains, di family of natural colour pigments wey betacyanin belong to, fit help reduce di symptoms and markers of inflammation. Dis include potentially relieving discomfort of inflamed joints, like knees. 4. E fit lower blood pressure Beetroot naturally dey rich in compounds wey dem dey call nitrates, and na dis make beetroot so heart-friendly. Dis na sake of say nitrates dey help to improve blood flow by relaxing di blood vessels, wey potentially dey lower blood pressure. Reduced blood. Studies suggest say nitrate-rich foods, like beetroot, fit also help in heart attack survival. 5. E fit improve exercise performance and support energy levels Studies suggest say wen athletes add beetroot juice to dia regime, e fit support exercise endurance and improve performance. No be all be dat: wen muscles dey resting state afta exercise, di nitrates in beetroot dey help bring more oxygen to di muscle cells wey dey promote efficient recovery. For di rest of us, to dey add beetroot in our diets fit be di energy boost wey we need. 6. E fit improve digestive health. Beetroots dey rich in fibre wey, as well as supporting bowel function, dey help promote healthy environment in di gut. Alongside di fibre, betawains dey help increase di production of short chain fatty acids by di beneficial bacteria wey dey live inside di gut. 7. E fit protect di gut. Beetroots na one of di richest vegetable sources of glutamine, one amino acid wey dey key to di maintenance of our gut lining. E also fit be say di glutamine fit play a role to protect di gut lining from injury and stress. 8. E fit support brain health and reaction time Further studies also suggest say higher nitrate intake appear to lead to significant improvement in motor functions, including reaction time. 9. E fit be useful addition to a post-menopause diet. Afta menopause, blood pressure and heart disease risk dey increase. Dietary changes like di inclusion of nitrate-rich vegetables show to be useful strategy to help keep arteries flexible and in turn manage blood pressure. To drink beetroot juice before exercise fit also help improve mobility and cardio-metabolic outcomes in dis age group. All of wey suggest say beetroot fit get useful inclusion as part of a balanced diet for post-menopausal women. Any improvement in blood flow go also benefit di brain. Studies suggest say to include beetroot in di diet, combined wit exercise, fit improve blood flow to di frontal lobe of di brain - one area wey involve for decision making and memory. 10. E fit relieve symptoms of Raynaud phenomenon. Raynaud phenomenon na one uncomfortable condition wia di blood to di fingers and feet no dey flow properly. Symptoms include pain, numbness and pins and needles. One initial study wey dey examine di effects of beetroot juice demonstrate improvements in blood flow to di thumb and forearm as well as reduction in blood pressure and inflammation. Caution Although dis findings look promising, sabi pipo say more trials dey needed to validate dem. Also, remember to consult sabi person and your doctor if you get any health issue and before you make any change to diet.

The Sun

a day ago

• The Sun

Doctors told me I'd never be a mum after childhood abuse damaged my body – but I got pregnant with an ‘Ozempic baby'

AFTER suffering years of sexual abuse, Stephanie Craig was given the heartbreaking news by doctors that she would never be a mum. The internal damage that she'd suffered due to the abuse which began when she was just a child, meant that it would be impossible for her to fall pregnant. 7 7 But after taking the weight loss jab Ozempic - Stephanie, 25, found herself staring at a miracle. Her pregnancy test stick was positive and she was expecting the baby she had always longed for, despite the doctors' predictions. She gave birth to her 'Ozempic baby' Callie in September last year, and is now enjoying being a mum. 'Even when I was in labour I didn't actually believe I was pregnant,' says Stephanie, who lives in Glasgow. 'It was only when Callie was placed onto my chest and I saw her for the first time that I actually believed she was mine.' Stephanie was in and out of children's homes as a child and suffered abuse from a young age. As she got older, she was put on the contraception pill by staff to prevent unwanted pregnancies in her teens and it caused her weight to balloon from a size 12 to a size 18 within months. She says: 'I actually developed an eating disorder at 18, when I was already around 20 stone in weight. 'I started to binge eat. I was so unhappy that it was a way of getting some control in my life. 'I was told at the age of 18 and at 22 by doctors on both occasions that I wouldn't be able to have children because of the internal damage I'd suffered. 'So I never thought I'd be a mum.' It was watching TV and seeing that James Argent from Towie had undergone gastric sleeve surgery that spurred Stephanie into action to lose weight. She said: 'I rang my friend straight away and told her that I wanted to have gastric surgery like Arg had done. 'As soon as I saw it, I knew that it was going to be the right answer for me. 'I'd tried joining slimming groups from the age of 18, but nothing had ever worked for me. So I got on and booked it straight away.' Stephanie had the gastric sleeve operation, which she financed with her savings, at The Spire Hospital in Manchester in July 2021, when she weighed just over 22 stone. In just over 12 months she had lost a massive ten stone - and had dropped to just over 12 stone. Then because she had been left with so much loose skin from her weight loss, she underwent a tummy tuck and breast uplift in Turkey in July 2022, a thigh and bra line lift in January 2023 and finally a reverse tummy tuck and thigh lift in August 2023. 7 7 7 She says: 'I felt amazing after I'd lost all the weight, but I had so much loose skin, that I had a number of cosmetic surgeries to remove it. 'My body looks so much better now. I had some savings, and it was worth every penny to finally get the body that I'm happy with. It's given me so much more confidence.' And there were more surprises to come. Stephanie took the weight loss drug Ozempic in November 2023, after the surgery had been completed, to try and lose a few extra pounds, and a few weeks later, she made the most amazing discovery. She had fallen pregnant. She says: 'I didn't believe it. I did lots of tests and they all came up positive, but I still didn't believe that I was actually pregnant. CAN OZEMPIC BOOST FERTILITY? Experts believe the 'Ozempic baby' phenomenon could be down to the major weight loss associated with the drug. This is because any weight loss, especially in those with PCOS, is known to boost fertility. The drug may also increase the chance of pregnancy because side effects such as nausea and vomiting may stop contraceptive pills from being absorbed properly. Dr Nerys Astbury, nutrition scientist and senior researcher in diet and obesity at the University of Oxford, said it was 'plausible' semaglutide injections, by reducing people's weight, could help improve fertility. 'It's nothing special about the drug,' she told the newspaper. 'The effect the drug has is on promoting weight loss. 'It is important to note that whilst some doctors are prescribing semaglutide off-label to women with PCOS, it is not clear whether it's safe to use in women during pregnancy.' She added: "It should not be used as a method to treat infertility until research demonstrating safety and effectiveness is available and until regulatory approval for use in those before and during pregnancy.' Prof Barbara McGowan, from King's College London, added: "Women on GLP-1 agonists should take contraception whilst they take the medication and stop at least two months before trying for fertility." "Healthcare professionals should include this advice when the medication is started.' 'I'd had lots of investigations over the years because of the sexual abuse I'd suffered, and had several laparoscopies, where a camera Is inserted down the fallopian tubes, and it had shown that I'd suffered a lot of internal damage. 'Because of that, the doctors always said that I wouldn't be able to fall pregnant. So to find myself looking at a positive pregnancy test stick was unreal.' It is believed that the weight loss medication, which is also used for diabetes management, can improve ovulation and menstrual cycle regularity, leading to increased fertility and potentially unintended pregnancies. She says: 'I only took it for a couple of weeks, but it certainly must have changed something in my body for me to be able to fall pregnant like this. 'Even as my bump grew, I still didn't believe there was an actual baby, even when I went for scans and saw her moving, and then even in labour. 'The only time I actually believed it was when she was handed to me for the first time, and I gave her a cuddle.' Baby Callie, who was born in September last year, is now nine months old and has just started nursery. Stephanie adds: 'It's a lovely feeling being a mum, and I know that I've got Ozempic to thank for that. I took it to lose a few pounds, but ended up with a surprise baby. 'She's a little miracle.'

Daily Mail​

2 days ago

• Daily Mail​

African gay men blame President Trump for their recent HIV diagnoses after he cut prevention funding

Gay men in Africa are blaming President Trump's decision to cut funding for HIV /AIDS prevention for their diagnoses of the virus. The administration's sweeping cuts to foreign aid have reduced access to medications like Pre-Exposure Prophylaxis, or PrEP, which decreases the risk of contracting HIV by 99 percent. Emmanuel Cherem, 25, a gay men in Nigeria, told Reuters that he tested positive for HIV two months after losing access to the US-supplied drug. 'I blame myself... Taking care of myself is my first duty as a person,' he said. 'I equally blame the Trump administration because, you know, these things were available, and then, without prior notice, these things were cut off.' Echezona, 30, another gay man from Nigeria, told Reuters that he took PrEP pills daily for three years until he was told by a clinic worker that the drug was now only available to pregnant and lactating women. 'I just pray and wish that Trump actually changes his policy and everything comes back to normal so that the spread and transmission of the virus would be reduced,' he said. Trump issued an executive order on his first day in office that paused foreign development assistance for 90 days, while Secretary of State Marco Rubio signed a 'stop work order' to employees of the State Department's Office of Foreign Assistance. The department oversees the US Agency for International Development (USAID) and the President's Emergency Plan for AIDS Relief (PEPFAR), which have seen drastic cuts since Trump took office. The administration has defended its position, arguing that other countries need to shoulder the burden of providing aid. During South African President Cyril Ramaphosa's White House visit, Trump acknowledged that the foreign aid cuts have been 'devastating.' 'Hopefully a lot of people are going to start spending a lot of money,' Trump added. 'I've talked to other nations. We want them to chip in and spend money too, and we've spent a lot,' he continued. 'And it's a big - it's a tremendous problem going on in many countries. A lot of problems going on. The United States always gets the request for money. Nobody else helps.' Russell Vought, the director of the US Office of Management and Budget, echoed Trump's stance during a Congressional committee meeting in early June. He argued that African countries should take on the responsibility of fighting HIV/AIDS, alleviating the financial burden on the US. Vought added that some of the nonprofits facilitating HIV prevention programs 'are not geared toward the viewpoints of the administration.' The director's comments are in line with a waiver issued to PEPFAR programs on February 1 allowing prevention programs to restart only for pregnant mothers. Vulnerable populations, like members of the LGBTQIA+ community, sex workers, or injecting drug users, weren't included in the prevention measures. PEPFAR grants often covered the cost of clinics supplying PrEP at public health centers for these populations, which have suffered closures due to decreased funding. A spokesperson for the State Department told Reuters that PEPFAR-funded programs would continue to be reviewed for 'assessment of programmatic efficiencies and consistency with United States foreign policy.' Public health officials and activists fear that if Trump's hardline policy toward foreign aid stays consistent, HIV infections will continue in the region. Linda-Gail Bekker, an HIV expert at the University of Cape Town, said that African countries may not cover the expense of supplying the drug, leaving a gap for more diagnoses. 'It's as predictable as if you take your eye off a smoldering bushfire and the wind is blowing: a bushfire will come back,' she told Reuters. Countries like Malawi, Zimbabwe, and Mozambique were almost entirely dependent on US funding for HIV prevention measures, according to UNAIDS. Other countries, like Ethiopia, responded to the USAID funding cuts by introducing a new payroll tax to pay for HIV medication previously provided by US funding. Medical advancements for HIV prevention and treatment have progressed significantly in recent years. However, UNAIDS projects that gaps created by a lack of funding could see steps backward.