Taking Care of Herself for the Sake of Her Child

Nteboheleng is a soft-spoken 29-year-old woman with a round face and brilliant smile. She lives in a cement block house in Mafeteng, Lesotho, and works as a quality control officer at a local textile factory. A part-time student, Nteboheleng hopes to eventually get a higher paying job.

When Nteboheleng discovered she was pregnant with her second child, she waited nearly five months – much longer than recommended – to have her first prenatal visit. Nteboheleng knew with this visit, she would also learn her HIV status, something she had delayed for years.

The suspicious behavior of a past partner made her nervous that she had contracted the virus, but she was scared to learn the truth.

“I was suffering to go, but afraid of the psychological stress of learning my [HIV] status,” she explained. But, with a new baby on the way, she knew she needed to take care of herself for the sake of her child.

When Nteboheleng finally visited a maternal and child health clinic, she learned she was HIV-positive and immediately started antiretroviral treatment (ART) to protect her unborn child from becoming infected with HIV.

Nteboheleng’s immediate enrollment on treatment is a result of the World Health Organization’s guidelines for lifelong treatment of pregnant women living with HIV. In 2013, the Lesotho Ministry of Health and its partners adopted these recommendations, often referred to as “Option B+.”

Before 2013, when Lesotho was still following the 2010 WHO guidelines, pregnant women who tested positive for HIV underwent CD4 count testing before being enrolled into any kind of treatment. CD4 cells are white blood cells that can, when measured, be an indicator of immune system strength or disease progression.

Women with CD4 counts below 350 were immediately enrolled on lifelong ART. Women with CD4 counts above 350 received a temporary antiretroviral drug regime, designed specifically to protect their baby during pregnancy, childbirth, and breastfeeding. The regimen was stopped after the baby was weaned and the mother-to-child HIV transmission risk period was over.

The World Health Organization recommended the implementation of Option B+ guidelines in 2013 because of mounting evidence that treatment improves health at any CD4 count. Option B+ is also recommended because it can help prevent infection in future pregnancies and serodiscordant relationships – in which one partner is HIV-positive and the other is negative.

Now when a pregnant woman tests positive for HIV at a health clinic that follows the latest guidelines, she is immediately enrolled in lifelong treatment, as Nteboheleng was, regardless of her CD4 count.

It is thanks to organizations such as the Elizabeth Glaser Pediatric AIDS Foundation, which receives PEPFAR funding and has been implementing the transition to Option B+, that more lives are being saved.

This continuation of treatment means ART will protect the life of Nteboheleng’s child through pregnancy, childbirth, and breastfeeding – as well Nteboheleng’s own health throughout the course of her life.

“I am now OK with my status,” Nteboheleng said. “I thought when I learned I was HIV-positive I was going to get sick. But I am now stronger than before. Getting into treatment before I got sick … I really appreciate that.”