How safe is your baby?
17 September 2007, 07:33
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Parents demand answers to HIV puzzle
'I knew there had been a f***-up'
Violet was forced to turn her five-month-old son's life support system off a week after she was told that he was HIV-positive - but no one has ever been able to tell the HIV-negative mother why.

Now, following research showing that at least 42 babies and children are suspected to have been accidentally infected with HIV in state hospitals, doctors are pointing the finger at the continued "largely inadequate infection control" that they believe is behind these unexplained infections and the four deaths that followed them.

In addition, at least six families from Cape Town (where 70 percent of the unexplained HIV cases have been found), Gauteng and Port Elizabeth are taking or considering legal action against the state for what they describe as the total violation of the "duty of care" government hospitals owed their children.

Research conducted by a group of Western Cape scientists and doctors and subsequent investigations by the Human Sciences Research Council and Treatment Action Campaign has painted a disturbing picture of HIV-infected expressed breast milk being given to premature babies, the re-use of dirty syringes and poor sterilisation of medical equipment in state hospitals.

In one case, five babies from a Western Cape hospital were infected with HIV after they were apparently given formula mixed with expressed breast milk from an HIV-positive woman. One of the infants later died.

But, despite the growing numbers of suspected "nosocomial" (hospital-based) HIV-infections being identified, the state has yet to support the establishment of a register of these cases - effectively tying the hands of the doctors and scientists who want to track the source of unexplained HIV infections.

The national health department has yet to respond to email queries, sent on Thursday last week, about the tracking of such cases.

Earlier this year, however, Western Cape health authorities reached an undisclosed out-of-court settlement with an HIV-negative Muslim couple whose baby daughter was believed to have been given infected breast milk while at the Mowbray Maternity hospital or Red Cross Children's hospital.

According to the TAC's research, this case "made it clear that HIV is indeed being transferred in hospital settings as a result of inadequate management and handling protocols".

Dr Shaheen Mehtar, an infection prevention and control expert, who helped investigate the case in which six Bulgarian medics were later found guilty by a Libyan court of infecting 400 children with HIV, believes the suspected accidental HIV infections that have been reported from local state hospitals are only "the tip of the iceberg".

"I'm sure it's happening all over the place … but even if it was only one case, it would be unacceptable. How dare you, as a hospital, give someone else's child HIV?"

Mehtar's belief that suspected nosocomial HIV-infections are the tragic result of patchy infection control measures is echoed by the TAC's research into such cases.

"The data obtained in this study … casts an even larger suspicion upon the state of infection control generally in the South African public health sector," the report concluded.

So why has it taken so long for parents to take legal action over their children's unexplained HIV infections?

Red Cross Children's hospital's Dr Brian Eley, who pioneered the first studies into the suspected accidental HIV infection of babies and children with Stellenbosch University Professor Mark Cotton, believes many of the parents of such children were often too afraid of the stigma around HIV to take legal action.

"They are very angry about what has happened … but they're also embarrassed by what other people will say," he said, after revealing that, since 2004 research found 14 unexplained HIV cases, Red Cross had treated another seven cases.

Violet confirmed Eley's opinion when the Cape Times spoke to her this weekend about her son's untimely death.

"I was afraid to speak about what happened. I was scared people who look at me and think I was the one who did this to my child."

Like many of the other HIV-infected babies whose parents were shown to be negative, Violet's baby was born premature, at 33 weeks, and was repeatedly fed with expressed breast milk.

It was not long before his health problems started to show. "His head was bigger than his body, he never had any baby fat and you could see his little ribs through his skin, but every day I would go to Tygerberg hospital and sit with him and would tell myself, 'he's going to make it, he's going to make it.'

"A week before he died, one of the doctors came to me and asked me if they can do an HIV-test on my baby and I said okay. The next day they told me that the test is positive and I must also go for a test. But I was negative."

Seven days later, Violet was asked to make a terrible decision.

"The doctors told me there is nothing more they can do for him and he will probably not live past midnight. So we decided to switch the machines off at six that night. I did not want my baby to suffer.

"My husband went crazy …he wasn't with the baby like I was because he had to work, and so he didn't see how he got sicker and sicker. He never expected this to happen ...

"The doctors asked me if I wanted counselling, but I was so hurt inside, I was cross with everybody … no one could tell me why my baby was gone."