Thubelihle Ndlovu, 34, hugs her sleeping two-month old baby so tight that he wakes up with a start. "I wanted a baby very badly but had given up hope of ever having one till I came to Witkoppen," she says.
Ndlovu and her partner Goodwill are HIV positive. Their baby Ziqondiso is not.
They are the first couple to have a baby at the year-old Safer Conception Clinic for HIV couples at Witkoppen Health and Welfare Centre in the northern suburb of Johannesburg in South Africa.
Witkoppen caters to the neighbouring squatter settlements of Diepsloot, Msawawa in Kyasands, Thabo Mbeki in Lion Park, Pipeline, Dihokeng and Riversands where hope runs low and unemployment runs high at around 46%. Many families don't have access to electricity, sewerage and running water.
HIV prevalence is high. As compared to HIV prevalence of 12.2% in South Africa in 2012, prevalence among young people aged 15-49 years in squatter settlements such as Diepsloot is 17.9%, which explains the need for Safer Conception Clinic.
"To minimise HIV transmission to the baby, couples are put on ARVs (anti-retrovirals , or drugs used to treat HIV) irrespective of their CD4 count, and given advice on nutrition, conception and self insemination, if needed, to increase the chances of conceiving," said Rebecca Phafa, the clinic's conception specialist. Current World Health Organisation guidelines recommend ARV prescription for CD4 count falls below 350 cells/mm3, as against the normal range of 500-1,500 cells/mm3.
Since it opened in July 2013, 160 women have enrolled for treatment. "We've had 15 pregnancies and two women recently had babies," said Phafa.
In India, as in many parts of the world, a single oral dose of 200 mg Nevirapine at the onset of labour followed by 2 mg/kg of Nevirapine syrup to the newborn within 72 hours of birth lowers risk of HIV transmission from an infected mother to the newborn. Mothers are also advised not to breastfeed the baby to cut infection risk further.
With the "Mississippi baby" thought to have been cured of HIV testing positive for the virus last fortnight, the spotlight is back on preventing HIV transmission. Because of good nutrition and treatment, Ndlovu's baby boy was a healthy 2.9 kg, unlike the more 20 million infants born each year weighing less than 2.5 kg (5.5 pounds).
Almost 40 % of all low-birth weight babies (less than 2.5 kg) are born in India. Around 14% babies in Sub-Saharan Africa and 15% in the Middle East/North Africa are born with low weight, shows UNICEF data.
There's hope. It's poor nutrition and bad health, and not race or ethnicity, that cause disparities in foetal growth and newborn size, reported The Lancet, Diabetes & Endocrinology last week. Overturning conventional wisdom that race and ethnicity were responsible for differences in the size of babies born in different populations and countries, data from INTERGROWTH-21st study involving almost 60,000 pregnancies in Brazil, China, India, Italy, Kenya, Oman, UK and US showed that babies born to healthy mums worldwide are strikingly similar in size.
"Currently we are not all equal at birth. But we can be," said the lead author Professor Jose Villar from the University of Oxford. "We can create a similar start for all by making sure mothers are well educated and nourished, by treating infection and by providing adequate antenatal care."