Andra, 6, and his 8-month-old baby brother Andre — not their real names —looked physically healthy, with no signs of being born to a mother infected by HIV.  

Andra tested negative for HIV, while his little brother will be tested within 10 months.

“I hope Andre is not carrying the virus in my body,” said his mother, Rani. Andra and a number of children in Jambi with HIV-infected mothers are free from the deadly virus. Rani’s hopes for her infant’s health are understandable given the difficulties she experienced up to her delivery.

When Rani visited hospitals to organize for her delivery several weeks before she was due, they all flatly refused to help her give birth, even Raden Mattaher Regional General Hospital (RSUD), which the minister of health referred as a hospital for people with HIV/AIDS.

Luckily, Rani received help from the Indonesian Network for HIV Infected (JOTHI). This organization often helps expectant mothers with HIV.

“I was then taken to Muhammad Husni Thamrin Hospital in Palembang,” said Rani. Rani left for Palembang, South Sumatra, with Yuli, JOTHI’s coordinator, by public bus in the evening.

“With childbirth only a few days away, I had to get on a crowded bus to get maternity care in Palembang,” related Rani. She should have hired an air-conditioned car to reach her destination faster, but with a limited funds at her disposal, she had no other choice but to skimp on transportation to be able to meet her hospital expenses.

Arriving in Palembang in the small hours, Rani struggled to find accommodation as she had to avoid expensive hotels. She could not go to hospital that morning either because she wasn’t in labor yet. “Finally we stayed in the bus ticket office. Alhough it wasn’t convenient at all, we had no other choice,” added Rani.

Women with HIV are not allowed to give birth “normally” as this will transmit HIV to their infants. To prevent such infection, they have to have a cesarean. RSUD-Muhammad Husni Thamrin would have performed a cesarean on Rani if she willing to pay Rp 15 million for it. But citizens of South Sumatra holding health insurance cards (Askeskin) are normally exempted.  

Fortunately, a hospital midwife offered to help Rani get an Askeskin card by citing her as one of her family members. The card was soon issued. “I was charged Rp 500,000, which was all right as I didn’t have to spend Rp 15 million,” she said.

Yuli said she had accompanied at least five women to RSUD-Muhammad Husni Thamrin, mostly from low-income backgrounds. They had all been denied hospital care in Jambi. According to Yuli, RSUD-Muhammad Husni Thamrin offers free cesarean operations to HIV-infected mothers, although the mothers are required to buy the equipment and drugs for the operation. Combined with board and lodging costs, Rani eventually spent Rp 5 million on giving birth to her baby.

Maternity care in Jambi is less expensive, yet no hospitals are willing to help women with HIV. Yuli had the same experience.

“RSUD-Raden Mattaher rejected me in 2007,” she recalled. When she was getting closer to her due date, the hospital administered drugs to delay her childbirth. But Yuli kept urging hospital authorities to assist her in giving birth.

With most surgery personnel refusing to handle her, Yuli was referred to a hospital in Jakarta and told her delivery and transportation costs would be borne by Raden Mattaher. Even with her Askeskin card, Yuli still had to navigate complicated bureaucratic administrative requirements in Jakarta.

“Only half of the cesarean was reimbursed and I didn’t get any refund from the regional hospital
for my travel expenses to Jakarta,” said Yuli.

Secretary of Jambi’s AIDS Control Commission (KPAP) Azwar Djauhari said he had insisted that RSUD-Raden Mattaher provide delivery service for women infected by HIV. But he also admitted the hospital didn’t have trained staff yet to perform surgery  on women infected with HIV.

For the medical and paramedical training, KPAP has made a proposal to the Central AIDS Control Commission.

“We have no funds for this proposal. We’ve proposed the program but we haven’t received a response yet, possibly because of the limited funds available. Let’s hope this program will be implemented next year,” added Azwar.

RSUD-Raden Mattaher Director Ali Imron acknowledged his hospital wasn’t equipped yet to treat women with HIV because of the lack of special surgery instruments. There are no special operation rooms or maternity wards to separate HIV carriers from normal patients.

“We don’t have sufficient funding to provide all the equipment and facilities,” said Ali Imron.

According to him, It is crucial to separate HIV patients from non-HIV ones to prevent the disease from being transmitted, but more importantly to dispel the public’s fears. He believes that if uninfected patients find out they are operated on with the same instruments used on HIV-positive women and share the same rooms as them, most patients will leave Raden Mattaher, particularly if the news is widely circulated.  

Nonetheless, Ali Imron promised to continue to advise HIV-infected women. “We will refer them to other hospitals in Palembang or Jakarta,” assured Ali Imron.

For Yuli, RSUD-Raden Mattaher’s explanation is very disappointing and illogical.

“I myself had a cesarean at a Jakarta hospital. I’ve frequently assisted infected women at the Palembang hospital. The same surgical instruments were used for all patients. But the instruments used on us were then sterilized using a special method so as not to transmit HIV to general patients.

Doctors and nurses also wore extra protective gear so our blood wouldn’t infect them,” said Yuli.

For post-surgery care, HIV-infected and non HIV-infected patients still share the same rooms. But women infected with HIV sleep on mattresses covered in plastic. Hospital personnel will not reveal the identity of HIV carriers to other patients.

The number of HIV infected women is growing. Based on data from the Jambi Health Office, 41 women in their reproductive age in the province have contracted HIV. They also wish to have children.

RSUD-Raden Mattaher as an HIV-AIDS referral hospital will have to offer cesareans to them eventually.

In fact, it might become increasingly risky for Raden Mattaher to keep on rejecting HIV patients. Yuli claimed that a number of women with HIV who could not afford to give birth at Palembang or Jakarta hospitals were “forcing” their way into RSUD-Raden Mattaher by not revealing they were infected with HIV.

“This is very dangerous as HIV transmission may well be even more uncontrolled,” she pointed out.

— Photo by JP/Nurhayati

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