In Africa, AIDS programs target fathers

JOS, Nigeria -- Three babies squirmed on their mothers' laps. One wriggled free. The two others tucked their heads into the curve of their mothers' necks.

As they waited inside Our Lady of Apostle Hospital, the babies could serve as poster children for efforts to prevent the transmission of HIV from mother to child. All three mothers are HIV positive. All three children, doctors say, appear to be HIV negative; they hope test results will soon confirm that.

Sitting next to the mothers and their babies, though, was another sight to celebrate: a father.

For several years, these AIDS programs have trying to save the lives of babies and put their mothers on treatment throughout sub-Saharan Africa. Now the focus is expanding to prolong the lives of fathers -- but it hasn't been easy to persuade men to get tested or treatment, and their lack of knowledge is leading to untold more infections and deaths.

''Men, well, they fear HIV, they fear knowing whether they have it," said Harouna Masok, 32, the father of one of the babies, who also has tested positive for the deadly virus. ''It's not easy to find out. But I did because both husband and wife should know their HIV status, and both should know their options."

Here in the central highlands of Nigeria and in dozens of other locations around sub-Saharan Africa, health professionals are rapidly expanding programs that were designed at first to prevent the transmission of HIV from mother to child.

In the last few years, health workers have learned that programs screening pregnant women for HIV provide access also to fathers, other children in the family, and extended families as well. Now, programs are beginning to test entire families, deliver anti-retroviral drugs or other medication to those who need them, and offer counseling.

''What we hope to do is save the family," said Dr. Atiene Solomon Sagay, who runs a US-funded program in Jos aimed at stopping HIV transmission from mother to child. ''It's not just the babies that we want to save. The babies give us access to everyone."

But, in these expansions, program directors from Senegal in West Africa to Swaziland in the southern part of the continent are bracing for new problems.

''The danger of identifying one child who is positive means you probably will then identify three or more other infections," Dr. Richard Marlink, scientific director for care and treatment at the Elizabeth Glaser Pediatric AIDS Foundation, said in a telephone interview from Durban, South Africa. ''The parents or other family members may not know they are infected, and so the news can be quite dramatic."

Some worry that if the programs are successful, health clinics and hospitals, already finding it difficult to meet the demands of HIV patients, will be overwhelmed.

Marlink, who is also a Harvard AIDS researcher, said special efforts soon will be necessary to bring in men. He suggested that some centers may want to set up a separate program for men, which would offer counseling and support groups. ''You have well-baby clinics for babies, antenatal centers for pregnant women, but you have nothing for the men," he said.

At Jos University Teaching Hospital, where Harvard helps support an AIDS program that treats an average of 750 people a week, up from just a handful of patients four years ago, Dr. John Idoko and his staff have tried various methods of getting men to take HIV tests. His staff has long noted that roughly two-thirds of those receiving anti-retroviral treatment are women.

''We asked ourselves, 'Where are the men?' " Idoko said in an interview in his office one day recently. ''It has really struck us how hard it is to reach them."

Idoko's staff is now giving HIV-positive women ''love letters" that are to be delivered to husbands or boyfriends -- invitations for the men to accompany the women on their next visit. Idoko said more men are responding.

But the process will take time. During the first seven months this year in the Jos region's antenatal clinics, 1,553 women arrived at clinic for a pre-birth checkup. Of those, 90 percent agreed to be tested for HIV, an extremely encouraging result. Some 103 tested positive, or 7.3 percent. But of those 103 women, just 19 were able to bring their male partners in for testing -- fewer than one in five.

Back in Jos, the two other mothers who sat with Masok, a firefighter, and his wife, Ufulul, 27, a police officer, said they were largely powerless in their relationships with their husbands.

Gift Ngwu, 24, whose husband has refused testing, whispered to a nurse that she couldn't stay long -- that her husband might beat her if she didn't return soon. She also said her husband refuses to take an HIV test, and refuses to use a condom. ''He just says he doesn't have it, so he doesn't need to take the test," Ngwu said softly.

Angela Idika, 29, whose husband has been tested but never returned for the results, said she would prefer not having another baby, but she said if her husband insisted, she would acquiesce. ''You know men," she said matter-of-factly, ''they have an upper hand over women."

Masok had only just met the two women, but he spoke up: ''You need to advise your husband that it is not so easy to keep on producing babies if you are HIV positive," he said. ''You shouldn't take marriage as a children's factory. To keep producing is just not advisable."

The other women said nothing, and Masok, too, turned quiet.

John Donnelly can be reached at donnelly@globe.com.