In Countries with Low HIV Prevalence, Integrating HIV and Reproductive Health Services is a Lifesaver for Women and Children
This post is the second in a blog series on maternal health, HIV, and AIDS. To view the entire series, click here.
In settings where general population HIV prevalence is low (<1%), as in many parts of Latin America, Asia and Eastern Europe, policymakers and programmers are encouraged to focus their prevention and testing efforts on the most at-risk populations. In Latin America, these populations are mostly comprised of men. This often means that women from most-at-risk populations lack services tailored to their particular needs and other women are largely left out of HIV prevention and testing efforts. This is a major public health concern given what we know about early diagnosis of HIV/AIDS: Early diagnosis can lead to timely entry into care and treatment, can facilitate prevention of mother-to-child HIV transmission, and can contribute to preventing sexual HIV transmission. In order to reach women in such settings, it is crucial to capitalize on women’s contact with the health system—and this means integrating HIV education and testing into reproductive and maternal-child healthcare services.
My research with HIV-positive women of reproductive age in Mexico illustrates the negative consequences of missing opportunities for HIV testing in reproductive health services, specifically prenatal care. I interviewed 55 women with HIV from Central Mexico who had had a pregnancy since 2001, when the offer of HIV testing during prenatal care was first included in the National Action Plan on HIV and AIDS. Despite universal attendance at prenatal care, less than half of the women interviewed were actually offered HIV testing. Delayed diagnosis, disease progression, and in some cases deaths of children and male partners resulted. Failure to diagnose HIV during a woman’s first pregnancy also resulted in additional HIV infections among younger siblings.
This was compounded by the failure to offer HIV testing and misdiagnosis of women and children when they sought healthcare after developing symptoms of AIDS. The failure to recognize AIDS among women and children or consider HIV-testing resulted in expensive and unnecessary diagnostic testing and treatment. In some cases, delayed diagnosis resulted in child deaths. An HIV-positive mother described seeking a diagnosis and treatment for her son, who died and was diagnosed with HIV posthumously: “Paediatricians and more paediatricians, private ones, and the best—we spent so much money. I tell my husband: I wouldn’t care about all of the money in the world if he was here and healthy…We paid money, and we bought medicines, and nothing. And we got deeply into debt. And for what? Nothing. Doctors and doctors and nothing. Why didn’t it occur to them to think just for a minute about [HIV]? And we didn’t either because we never could have imagined it.”
In low prevalence countries like Mexico where HIV remains an “unimaginable” diagnosis for married women of childbearing age, prenatal care and other sexual and reproductive health services provide unique opportunities for women to learn they are HIV-positive, and to access lifesaving treatment for themselves and their children.
In 2011, there were 429,000 women living with HIV in Latin America—making up about a third of the 1.3 million people with HIV in the region [UNAIDS 2012]. More than 13,000 Latin American women of reproductive age died of HIV or AIDS-related causes in 2010. And notably, more than twice as many women aged 15-49 died from HIV or AIDS than from direct maternal causes [IHME Global Burden of Disease]. Yet the links between HIV and women’s health remain at the margins of many regional and country level policy discussions and programming decisions in both HIV and maternal health [Kendall and Lopez-Uribe, 2010].
I look forward to participating in the upcoming technical meeting, Maternal health, HIV, and AIDS: Examining research through a programmatic lens, starting on 10 June 2013, in collaboration with USAID and CDC. The purpose of the meeting is to discuss emerging research linking maternal health and HIV, identify research gaps, and consider programmatic implications.
Please stay tuned to the MHTF Blog for updates from the meeting.
To view the full blog series, click here
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If you are interested in sharing a guest blog post for our series on maternal health, HIV, and AIDS, please contact Kate Mitchell (kmitchel@hsph.harvard.edu) or Samantha Lattof (slattof@hsph.harvard.edu).