This mother has birthed and breastfed two healthy baby girls. She is also HIV positive

• If you're HIV positive, is it still possible to fall pregnant safely?
• Can you breastfeed your children without transmitting the virus?
• Nozi Samela was diagnosed with HIV in 2005 and has since birthed and breastfed two healthy baby girls. This is her story.

Nevertheless, assumptions about the virus still run riot, and the stigma surrounding those who are HIV-positive continues to perpetuate false information about those living with HIV. These challenges proliferate when a woman who is HIV-positive falls pregnant or decides to have a baby.

Nozi Samela was six months pregnant when she found out that she had HIV. When the nurse disclosed her status, two quick and successive thoughts flooded her mind: 

One, the child that she would birth in just a few short months would be born HIV positive. Two, she was done for.

"It was 2005, and I had seen headlines about the number of people in South Africa dying from Aids-related illnesses. I thought that was the end of me. I didn't hear anything else that the nurse was saying other than, 'I will take you to a room where you'll meet other women like you.'"

Also see: Author and HIV activist writes children's book to 'continue destigmatising HIV'

HIV is not a death sentence

Nozi trailed behind the nurse, visualising a room filled with weak, sickly women nursing their weak, sickly babies. So when she and the nurse arrived at their destination, Nozi assumed they were lost.

"I walked into a room full of happy women sharing a meal, their babies laughing and playing on the floor. I was sure that they couldn't be mothers who were HIV positive. I wondered if somebody had bribed them to say that they were."

Despite her misgivings, Nozi was welcomed into a fold of women who would guide her through her pregnancy and two subsequent ones. They would introduce themselves and their children. They would share their status and their stories. They would hold Nozi in one of the scariest moments of her young life and assure her that she would be all right. They would teach her that HIV is not a death sentence. 

From these mothers, she would also learn that her child could be born without HIV, and that's when Nozi really sat up to listen. If there was even an ounce of possibility that her baby could live free of HIV, she was going to do whatever was necessary to make sure that would happen.

Years later, these mothers would not only support Nozi through two subsequent pregnancies, but they would also give her all the information needed to breastfeed her babies without risk of transmission.

Undetectable = Untransmittable

Within days of her diagnosis, Nozi started on antiretroviral (ARV) treatment. Taking ARVs is imperative for a pregnant woman living with HIV because:

• It reduces her viral load (the amount of HIV virus in her blood), which also decreases the chances of passing the virus on to her baby in utero.
• It helps protect the woman's partner if he or she is HIV negative. 

Nozi explains that when a woman is on ARVs over a long period of time, the ARVs suppress or lower the amount of virus in their blood to such a degree that it's undetectable when they do standard tests.

"A low viral load means there is less chance that a woman can transmit HIV to her sexual partner or unborn baby. And if the viral load is undetectable, then it is also untransmittable."

Also read: Sperm washing offers hope for HIV positive men wanting to start a family

Formula feeding perpetuated HIV stigma 

During Nozi's first pregnancy in 2005, women living with HIV were not allowed to breastfeed their babies. In addition to intercourse and in utero transmission, breastfeeding is considered one of the ways that someone with HIV can transmit the virus to another.

At the time, government protocol was to provide mothers with formula for the first six months of her child's life. This was no doubt effective in reducing mother-to-child transmission countrywide, but it was also an unhelpful red flag that perpetuated an unhealthy stigma around having HIV.

Across many communities in South Africa, when a mother opted to feed her child formula, friends and family members immediately assumed that the mother was HIV positive, whether this was the case or not. 

Were it not for the problematic stigma already associated with being HIV positive; formula feeding wouldn't be an issue. Fed is, after all, best. However, mothers who choose to formula feed still feel pressured to disclose their positive status when they aren't ready, or they pressure themselves to breastfeed under difficult conditions so that they are able to keep their status private.

"I felt like I didn't have a choice in whether or not I disclosed my status to my family. I felt forced to do it like I couldn't choose when, where or how I would disclose my status. That might still be the case today, even though the feeding protocol is vastly different to what it was 16 years ago. Now, we actually encourage women living with HIV to breastfeed," says Nozi. 

A mother needs the right tools to formula feed her baby 

With millions of families across Africa living without access to safe and clean running water or the means to sanitise bottles and feeding utensils, it stands to reason that breastfeeding is a safer infant feeding option in the African context, not to mention cheaper.

"We can't run away from the fact that formula is expensive. It also takes time and a lot of commitment to safely prepare a bottle. A mother needs the right tools to formula feed her baby. Breastfeeding is, of course, difficult and challenging, but it's free, it's affordable, it's readily available, and it's safe to do even when you're HIV positive," says Nozi.

That is, as long as you are exclusively breastfeeding.

"Babies have a mucous-like lining that protects them from any kind of germs or bacteria – not just the HIV virus. If a mother gives the baby anything else while the child is still young, when that mucus lining is still not thick enough, it might wash away the lining, which opens spaces for HIV to get into their bloodstream.

"Nozi explains that exclusive breastfeeding is like a second barrier method that protects the baby from mother-to-child transmission (the first barrier is ensuring that both mother and child take ARVs). It is therefore imperative that breastfeeding mothers who are HIV positive only offer their baby breastmilk and doctor-approved medication until the mother and baby are ready to wean.

Mentor Mothers

The group of women that held and supported Nozi as she navigated birth and breastfeeding with a positive status were members of mothers2mothers (m2m), an international non-profit organisation that educates and empowers mothers who are HIV positive. 

With a goal of ending AIDS in our lifetime, m2m employs and trains local women living with HIV as community health workers (AKA, Mentor Mothers). These are women who support women, children and adolescents with medical services, education and support.

Soon after delivering her first baby in 2005, Nozi joined the team of mentor mothers, and now, 16 years later, she works in the Cape Town head office as Senior Communications Manager. 

If you are pregnant and HIV positive, know that you are not alone. Contact m2m to get in touch with a Mentor Mother at a clinic near you, or ask your doctor or clinician to put you in touch with an organisation in your area that can help you connect with women close to you living with HIV.

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