It’s hot and dry, the rains are late to arrive, and the subsistence farmers in Zambia’s Southern Province hungrily await the next growing season. Often there is only a solitary rural health center, staffed by a single nurse midwife and a few volunteers, where a pregnant woman living with HIV can receive the care she needs. “Most of the centers are too far away and women may start to deliver on the way or at home because they run out of time. Women come to the facility by ox cart, bicycle, a hired vehicle or walking, perhaps even being carried by her husband,” said Miriam, a lay counselor (LC) in Southern Province.
The remoteness of available care also increases the vulnerability of women and their unborn children to HIV. In this strongly patriarchal society, the average woman bears more than six children. With low male support for antenatal care (ANC) and services for prevention of mother-to-child transmission of HIV (PMTCT) and only her feet to carry her the many kilometers to the health center, she is challenged to keep her soon-to-be-born child HIV-free.