HIV: Rising to the challenge of helping mothers
Wednesday 2 June 2010
Last week I was at a two-day conference on Sexual and Reproductive Health and HIV, where five research programmes funded by the Department for International Development were being presented, half way through their life cycle.
The conference covered many varied topics — from missed opportunities in prevention of mother to child transmission of HIV; to the debate around “Universal Test and Treat”, whereby people living with HIV are treated as soon as they test positive.
As always at conferences, statistics were flying around, and nowhere less so than when talking about preventing transmission of HIV from mother to child.
Out of all the women dying during pregnancy in South Africa, at least 43% — and according to some as many as 50% — are dying of AIDS-related illnesses.
That has major implications for our programmes around maternal and child health.
In South Africa, 18% of the population are living with HIV. We do have a programme to prevent mother-to-child tranmission in South Africa, which tracks mothers and their babies.
Effective interventions have been developed which have reduced mother to child transmission of HIV from up to 40% to under 1% - a major leap forward in addressing the pandemic.
However, another major problem is that only 45% of pregnant women who are living with HIV can get access to these interventions.
In addition, many HIV positive people – and for that matter, those without HIV – simply don’t have access to family planning methods or information, and so unwanted pregnancies abound.
Recently, I met a couple in a rural Ugandan village called Julius and Helen, who had just given birth to their eighth child.
They both know that they are living with HIV, and they don’t want to have more children – eight is more than enough for them - but they don’t know the basic facts of how to prevent pregnancies.
Condoms are not widely available where they live. Julius is very supportive of Helen and accompanied her to her ante-natal appointments (which is unusual for a husband to do), but when Helen went into labour and gave birth at home, they had lost the Nevirapine tablet she had been given by the health worker.
This tablet should have taken to prevent HIV transmission from her to the baby, so that link in the chain of interventions was broken. They didn’t know that the baby should also have had a drug within 72 hours of being born; another broken link.
So where are we going wrong?
- Testing. Only 20% of the 33 million people living with HIV worldwide know their status, so those who are HIV positive but don’t know it won’t access treatment. A higher percentage of women than we had originally realised get HIV while pregnant so, even if they test negative, they should be retested three months later to account for this.
- Failure of women to take their antiretrovirals. This can be for a number of reasons: affordability of “free care” - the cost of transport, drugs, food, consultation fees and opportunity costs; accessibility to health centres – time, travel over long distances, and acceptability - attitudes towards people living with HIV, stigma, fear of knowing one’s status
- In addition, many women only attend the ante-natal clinic for the first time when they are 30 weeks pregnant, but many anteretrovirals should be initiated before that.
- There is an unmet need for family planning, as Helen and Julius demonstrate.
- Mothers are not being assessed for ART treatment with at least three active anti-retroviral medications (ARV’s) for their own health, not just for preventing transmission to their babies.
There is much to do. With maternal and newborn health a key priority for us in countries where there is a high HIV prevalence, we must rise to the challenge of preventing mother to child transmission of HIV, which is a cost-effective and proven intervention that can save the lives of hundreds of thousands.
Tags: antiterovirals, ART, babies, Department for International Development, development, DFID, family planning, health centres, labour, maternal newborn and child health, mothers, new mothers, population, pregnancy, preventing mother to child transmission of HIV, prevention, reproductive health, research, uganda, women
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