Connecting HIV to maternal and child health

The study, "Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5", published in the medical journal The Lancet projects that globally HIV has increased maternal mortality by 20 percent. In sub-Saharan Africa maternal mortality has been on the rise because of HIV, particularly in South Africa it is estimated that more than 50 percent of all maternal deaths can be attributed to HIV.

Researchers found that progress in reducing maternal mortality has been slowed by the ongoing HIV epidemic. Nearly one out of every five maternal deaths, a total of 61,400 in 2008 can be linked to HIV, and many countries with large populations affected by HIV have had the most difficulty in reducing their maternal mortality ratio. In 10 southern African countries, HIV causes up to one half of all maternal deaths, while in South Africa, from 2005-2007, the maternal mortality ratio was nearly 10 times higher in women known to be HIV positive. Michele Sidibe, the UNAIDS Executive Director noted at the Women Deliver conference in Washington DC this June, “this study serves as a powerful reminder that progress in maternal health efforts is hugely dependent on progress in the AIDS response in countries with the most severe HIV epidemics.”

The PLoS Medicine series article, "Sub-Saharan Africa's mothers, newborns and children: Where and why do they die?" on maternal and child health by Robert Black and colleagues, cites a study by Joy Lawn and colleagues in South Africa that reported approximately 300,000 mothers with HIV/AIDS give birth every year, with the toll of HIV infection contributing to 57 percent of all child deaths. According to the same article, 7.2 percent of all 6 week old infants attending their first immunization were already HIV infected, despite a national program launched in 2000 to provide single dose Nevirapine to HIV positive women in labor and to their infants postnatally. If South Africa were to scale up interventions for prevention of mother to child transmission of HIV (PMTCT) with appropriate feeding choices to cover 95 percent of mothers and newborns, more than 37,000 children could be saved each year. The authors say that HIV infected mothers' risk of dying is ten times higher than that of HIV negative mothers. About 16 million women over the age of 15 are living with HIV worldwide.

A stronger recognition of the linkages between HIV and maternal and child health is necessary to improve the health of affected populations. UNAIDS Goodwill Ambassador Annie Lennox giving the welcome address at the Women Deliver conference said, “I believe that the AIDS response is an excellent entry-point to better invest in women and girls at all levels, and to advance women's sexual and reproductive rights. We need to empower women and girls so that they can better protect themselves and take control of their own sexual and reproductive health.”

Reducing the number of children who die before the age of five is the fourth Millennium Development Goal (MDG 4), while doing the same for mothers during pregnancy or childbirth is the fifth goal (MDG 5). The lack of progress on these goals so far means that the 2015 targets for maternal and child health are unlikely to be met. These two Goals are often referred to as the health related MDGs along with the response to AIDS, malaria and other diseases (MDG6). These three MDGs are closely interlinked and recent data has shown how HIV has prevented further progress in improving maternal health and reducing child mortality.

Ahead of the G8 Summit in Huntsville, Muskoka, Canada, June 2010, UNAIDS Deputy Executive Director for Management and External Relations, Jan Beagle, delivered the keynote speech at an event for Canadian Parliamentarians. In her address, Ms Beagle stated that the Joint UN Programme on HIV/AIDS (UNAIDS) was encouraged by the sharp focus of the Canadian G8 Presidency on child and maternal health. “As HIV is the leading cause of death among women of reproductive age, the global response to AIDS can and must be leveraged more effectively to meet women health needs.”

The Muskoka initiative is in line with the UN Secretary-General’s global Joint Plan of Action focusing on the health of women and children which was launched in April 2010. Ms Beagle called for an integrated approach to all the Millennium Development Goals and highlighted that MDG 4 and 5 cannot be accomplished without a strong commitment and real action on universal access to HIV prevention, treatment, care and support.

Prevention of mother-to-child transmission (PMTCT) of HIV is an important platform for family centered care and an entry point for maternal and child health (MCH) services. The scale up of mother-to child-HIV transmission programmes will enable women to receive sexual and reproductive services at the facilities where they receive PMTCT services. We can stop mothers from dying of HIV and dramatically reduce maternal mortality.

Support for PMTCT interventions could avert more than two million child HIV infections over the next five years, leading to elimination of mother-to-child transmission of HIV. However, more funding is needed, especially to expand services aimed at prevention of HIV among women of reproductive age, prevention of unwanted pregnancies among women living with HIV, and early infant diagnosis, care and treatment — these are all the key pillars of PMTCT.

The Global Fund has demonstrated it will finance family planning interventions and reproductive health supplies as critical components of HIV, TB, Malaria and Health Systems Strengthening applications. The decision, Exploring Options for Optimizing Synergies with Maternal and Child Health, marks the first time that the Board has so strongly acknowledged the links between MDG 4 (reducing child mortality), MDG 5 (improving maternal health), and the Global Fund’s core mandate of MDG 6 (combating HIV, malaria, and TB).The time has come for integrating and scaling up delivery of HIV prevention and treatment services within the context of maternal and child health care.

Ishdeep Kohli-CNS

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