Source: Thomson Reuters Foundation
In the small maternity ward of a run-down health clinic in Delft, a half hour drive from Cape Town, the wooden benches in the waiting area are filled with young women and girls from the poor surrounding townships.
Nozuko Manong, in her white-and-blue nurse's uniform, calls out a name and escorts a young woman into a small consulting room where the paint is peeling from the walls. Gently, Manong tells the patient the result of her HIV test. She is positive.
Thirteen years ago, Manong tested positive herself. For more than a decade she has been advising young South African women coming for pregnancy tests to get tested for HIV, part of her work for the support group mothers2mothers.
"I found out about my HIV the same time I found out I was pregnant. I couldn't believe it. But the next day I went to a mothers2mothers support group. To my surprise, there were beautiful women there, and their kids were negative," said the nurse.
In South Africa, with the world's highest prevalence of HIV, the testing of young pregnant women has led to a significant cut in transmission of the virus that causes AIDS from mothers to babies.
"Currently, about one percent of positive mothers pass HIV to their children, but we are aiming for zero percent transmission," Professor Sibusiso Sifunda of South Africa's Human Sciences Research Council told the Thomson Reuters Foundation.
Around 7 million South Africans are living with HIV, according to the United Nations. Four million of them are women.
If left untreated, the chances of a mother passing HIV to her unborn child is high. But Manong was put on anti-retroviral drugs after testing positive, stuck with the treatment, and her daughter avoided contracting the virus.
Since 2005, HIV testing has been compulsory for pregnant women in South Africa as part of the government's prevention of mother-to-child transmission programme. HIV treatment is now nominally free for all South Africans who need it.
Sanjana Bhardwaj, health and nutrition chief at UNICEF South Africa, said there had been huge strides in testing for and treatment of HIV in the last decade.
"(That has been) both in terms of preventing new infections in children as well as linking children who are infected to treatment and care," she said.
The number of new HIV infections in children aged up to 14 fell to just over 5,000 in 2015 from more than 30,000 in 2009, she said. Nearly three quarters of children living with HIV are able to access life-saving anti-retroviral treatment. Poverty and lack of awareness still stand in the way of all children accessing medication.
In 2014, the government said more than 95 percent of HIV-positive pregnant women were receiving antiretroviral medicine to reduce the risk of transmission.
But fear and stigma still surround the disease.
After her baby was born, Manong had to wait three months for the results of her daughter's HIV test.
"It was horrible. I was so scared to go back and get the result. But when I found out she was negative, I wanted to tell the world, also that I was positive, because I wanted other mothers to know about my healthy girl," she said.
Now she is a "mother mentor", offering support and health education to HIV-positive mothers and other women in a bid to reverse the trend. Similar mothers2mothers programmes have been rolled out in Kenya, Lesotho, Malawi, Swaziland and Uganda.
NOT A DEATH SENTENCE
Forty-year-old Tinny tested positive for HIV last month. "I came in because I thought I was pregnant. I was, but at the same time I found out I was positive," she told the Thomson Reuters Foundation in an airless consulting room in the Delft clinic.
"I was very scared and thought: how will my family react?" she said.
"When I found out it was not a death sentence but a disease, I realised it is something I can deal with. If I had not known my status, my baby for sure would have gotten HIV because I would have given birth at home (without medical help)."
Nurse Manong said despite campaigns to raise awareness about the importance of testing, women are scared of rejection from their communities if they test positive.
"It's easier not to get tested, it's safer for them in a way," she said.
Marney Natasha, operational manager of the Delft health clinic, said many struggle to disclose their status. "There is a lot of stigmatisation here," she said, sitting in her office.
Natasha has worked at the clinic since 1999, witnessing the progress. "Last year we had only two occurrences of babies contracting HIV in the area," she said.
The clinic registers around 20 HIV positive women a month, with numbers falling each year.
NEXT TARGET
While South Africa's focus has been on cutting mother-to child-transmission, a new target group is men. "We want to facilitate disclosure to the women's partners; that would make the men get tested," said Professor Sifunda.
Fatima, who looks older than her 32 years, found out about her positive status last week. "I did not get my period for three months and I was eating a lot, so I thought I was pregnant," she said at the clinic. "I tested HIV positive. I was shocked."
She has not told her partner yet. While she has found support at the clinic, she fears telling her family. "I don't think I will tell anyone. I'm dealing with it my own way."
Fatima is a typical example of South Africa's many HIV positive mothers, who have taken the first step in getting tested, but are unwilling to tell anyone their status.
"They need support, said Manong, stepping out of the full waiting room for a break. "This is where they come to get it."