Mother-to-child HIV transmission – stigma barrier to progress

Guest blog by  Ditte A. Søndergaard1, Simone C. Hald1,3, Jeffrey V. Lazarus2,3

1 Department of Public Health, Copenhagen University, Copenhagen, Denmark

2 Copenhagen School of Global Health, Copenhagen University, Denmark

3 The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland

Even though the technology and the means to prevent vertical HIV transmission are available, mother-to-child transmission is still the predominant route of infection for the more than 400,000 children who becomes infected with HIV each year (1). So despite the major progress in the prevention of mother-to-child transmission (PMTCT) by promoting and scaling up health services , we are still far from reaching the United Nations goal of no children being born with HIV by 2015. There are undoubtedly several reasons for this, one of them being the impact of HIV and AIDS-related stigma, which is one of the greatest barriers to dealing effectively with the HIV pandemic (2).

Mother-to-child transmission can occur during pregnancy, labour and delivery, or during breastfeeding (1). PMTCT services address these transmission points and can reduce the rate of transmission to 5% or lower. According to the World Health Organization, without an intervention, the risk of mother-to-child transmission ranges from 20% to 45%. (3). So why is the uptake of PMTCT so low in Africa, where it is most needed? To explore this, two of us travelled to the rural Kitui District in Kenya, in April 2009, to conduct several focus group discussions with Kenyan women of reproductive age (all either living with HIV or known to be at risk of contracting the virus) with the aim of discovering their thoughts on PMTCT initiatives.  We also carried out a number of key-informant interviews with health personnel to help validate the information obtained in the discussions.

We found that HIV/AIDS-related stigma was a major problem in the Kitui District and that it could affect the uptake of PMTCT services, in spite of the women being aware of the importance of this intervention for avoiding transmitting HIV to their newborns. The women reported that stigma can cause people in their circles to not even test for HIV or to not disclose their HIV status if positive. They also stated that testing and sometimes disclosure were part of attending PMTCT services (mandatory or not); hence, it might deter people from accessing them. One prominent reason they gave was that HIV and AIDS are associated with negative qualities such as “loose morals” and being a “prostitute”. As a result, they feared being excluded from their community if they disclosed being HIV-positive.

The situation in Kenya is far from unique and there are multiple causes of the high number of cases of mother-to-child transmission of HIV, in addition to HIV/AIDS-related stigma. Further, much has already been achieved in recent years and the goal of eliminating this form of HIV transmission by 2015 is reachable – even in Africa – though there is an urgent need for scaling up aid to ensure quality services and access to them. On 19 May, the Global Fund to Fight AIDS, Tuberculosis and Malaria, where two of us work, launched the BORN HIV FREE campaign with the support of  Carla Bruni-Sarkozy, the Global Fund Ambassador for the protection of mothers and children against AIDS. This campaign aims to mobilize public support for the Global Fund’s work and that of our partners on this issue, uniting us around the vision of a world where no child is born with HIV by 2015 (4).

The BORN HIV FREE campaign highlights one of the scourges of the 21st century. Please join us and show your support for the campaign by signing up at www.bornhivfree.org, where there are also links to our Facebook page and Twitter account.

References

1. The Joint United Nations Programme on HIV/AIDS (UNAIDS) & World Health Organization (WHO). AIDS epidemic update 2009. Geneva: Joint United Nations Programme on HIV/AIDS; 2009.

2. Elliot R, Utyasheva L, Zack E. HIV, disability and discrimination: making the links in international and domestic human rights law. J Int AIDS Society 2009, 12(29):1758-2652.

3. World Health Organization (WHO). PMTCT Stratigic Vision 2010-2015. Preventing mother-to-child-transmission of HIV to reach the UNGASS and Millennium Development Goals. Moving towards the elimination of paediatric HIV. Geneva: World Health Organization; 2009.

4. The Global Fund to Fight AIDS, Tuberculosis and Malaria. Born HIV Free [Internet]. Geneva: The Global Fund to Fight AIDS, Tuberculosis and Malaria, 2010 [cited 2010 May 19]. Available from: http://www.theglobalfund.org/documents/bornhivfree/godeeper_en.pdf.

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