Every year, many children are newly infected with HIV, mainly through mother-to-child transmission. An overwhelming majority – more than 90 per cent – of HIV infections in infants and children are passed on by mothers during pregnancy, labour, delivery or breastfeeding. In 2010, an estimated 1.49 million (1.3–1.6 million) pregnant women in low- and middle-income countries were living with the human immunodeficiency virus (HIV). Also in 2010, globally around 390 000 children were born with HIV.
There are many gaps between HIV and other sexually transmitted infection (STI) prevention programmes and maternal health services. There is little coordination between programmes for HIV, family planning, and maternal neonatal and child health (MNCH). There is also inadequacy of maternal health care providers and community-based caretakers. Preventing HIV infection in pregnant women simultaneously benefits the women themselves, their partners, and their children. The benefits of HIV prevention counselling and services provided during pregnancy can carry over into the postpartum period, when HIV risk is high, and throughout the woman’s lifetime.
According to Michelle Bachelet, Executive Director of UN Women, “We believe that the single most important strategy in dealing with HIV is empowering women and guaranteeing their rights—so that they can protect themselves from infection, overcome stigma, and gain greater access to treatment and care”.
Katy Pullen, Gender and HIV Program Manager, UN Women, rues that there are very few sustainable solutions available for women in respect of their sexual and reproductive health needs and rights. She informs that, “UN Women has recently underscored that persistent gender inequalities and women’s rights violations are continuing to render women and girls more vulnerable to HIV and prevent them from accessing HIV services. In 2010 there were around 17 million women living with HIV, and HIV continues to be the leading cause of death in women of reproductive age. Gender equality and respect for women’s sexual and reproductive health and rights, especially for women living with HIV, are essential for an effective response to HIV.”
Katy says,“Drawing on examples from the Southeast Asia region, I would like to highlight four areas cited by UN Women and UNAIDS as critical entry points for making HIV programmes more responsive to the needs of women – and this includes the sexual and reproductive health needs of women, particularly women living with HIV:
(1) Promoting the leadership and participation of women living with HIV, and women affected by HIV, in decision-making so that they can advocate for and contribute to policies and programmes that are responsive to their unique needs. This support is urgently needed as financial resources are at a critical level among positive women’s groups and networks in several countries in the region.
(2) Ensuring enabling environments and rights-based services for key affected women and girls. In a concentrated epidemic, this means targeted responses to removing the barriers to uptake of Sexual Reproductive Health (SRH) and HIV services among not only women living with HIV/AIDS but also other key affected women such as female sex workers, female drug users, and intimate female partners of men with high-risk behaviours.
(3) Strengthening national institutions to enable them to deliver on commitments made on gender equality and women’s rights in the context of HIV like in the Southeast Asia region where governments are strengthening national institutions in the area of gender equality. In Cambodia and Indonesia the National AIDS Authority and National AIDS Commission respectively, have ensured dedicated gender expertise by recruiting and appointing a full-time national gender expert to be housed within the coordinating body.
(4) Addressing the intersections between HIV, violence against women and access to SRH information which are increasingly recognized. In Southeast Asia, several recent studies with HIV positive women have shown how these intersections affect the lives of women living with HIV in ways that undermine and block their access to prevention, treatment, care and support services. There is evidence to indicate that women living with HIV are more likely to experience intimate partner violence than women among the general population. A 2008 study conducted by the Raks Thai Foundation in two provinces of Thailand found that 43% of positive women surveyed experienced violence but felt nothing could be done. While respondents generally felt that they had adequate access to HIV services, they identified far fewer service options for women confronted with violence. When asked where women might seek help to deal with violence, the majority identified private and informal sources, with a small proportion mentioning government services or the police.”
Rose Koenders, Executive Director at Asia Pacific Alliance for Sexual and Reproductive Health (APA) suggests that, “Pregnant women should have access to information, care and counselling. The increasing extent of mandatory and coercive testing needs to be addressed. Women living with HIV have reported force/pressure by health care workers to have abortions or undergo sterilization. Laws should adhere to principles of informed consent, confidentiality, counselling, and proper treatment and support. The whole HIV prevention must focus on looking at them as mothers and not just as women because they need a more comprehensive data and services when we look at mother to child transmission. There needs to be more of a holistic approach in the programme and it should include not only HIV prevention but also HIV prevention treatment support and care.”
Although a large number of women all over the world access maternal and reproductive health care services during pregnancy, only few of them are aware of their HIV status. Hence it is a very convenient portal for diagnosis and subsequent treatment to those amongst them who are HIV positive. Expanding HIV testing and counselling among pregnant women through Integration of HIV Prevention and MNCH can play a profound role in reducing the risk of mother-to-child transmission and providing treatment, care, and support for HIV-positive mothers and their families. It is hoped that the forthcoming XIX International AIDS Conference would ensure that governments, institutions and stakeholders come together to work for a more humane and integrated approach focussed on Maternal and Child Health for turning the tide of AIDS.