EDITORIAL: Prioritizing the prevention of HIV/AIDS in African women: A call for action

Abstract

HIV/AIDS currently pose severe threat to women’s reproductive health and social well-being in the African region. Available data indicate that of the nearly 22.9 million adults living with HIV/AIDS in the continent in 2011, slightly more than half were women1. The predominantly hetero-sexual mode of transmission of the virus in the region places women at greater biological risk for acquiring HIV/AIDS, the vaginal mucosa providing an easy surface for habituation and penetration of the virus. Additionally, the unequal power relations in sexual matters between men and women in most African countries, the socioeconomic impoverishment of women relative to men and the dis-empowering effects of harmful traditional and cultural practices, often place women at greater vulnerability for acquiring HIV/AIDS.

The effects of HIV/AIDS in women are manifold and can be cascading. Not only are women less likely to access evidence-based support and treatment when they are diagnosed with HIV/AIDS, they are also more likely to be stigmatized and to suffer social marginalization, ostracism, stigmatization and physical harm as a result of the disease. The effects in women of reproductive age who become pregnant add to the existing burden of HIV/AIDS in the African region. In 2010, an estimated 1.49 million (1.3-1.6 million) pregnant women in low- and middleincome countries lived with the virus. About 75 percent of these women were concentrated in 10 countries, which included Kenya, Mozambique, Nigeria and South Africa2. The resulting motherto-child transmission of the virus accounted for an additional 3.4 million cases of HIV/AIDS in children, which increased the overall global burden of the disease. The social effects of the death of a mother from HIV/AIDS are also unquantifiable, including the greater likelihood that the resulting orphans will die from largely preventable illnesses during their infant and preteen years.
Despite the greater burden and the more pervading consequences of HIV/AIDS in African women, there are to date, limited programs in the continent that specifically prioritize the prevention and treatment of HIV/AIDS in women. Most country-led HIV/AIDS prevention and treatment programs are often broad-based, are not gendersensitive and do not usually address the specific needs of women. Of greater concern is the fact that HIV/AIDS prevention programs in many
African countries often fail to address the multiple and complex mix of social, cultural, psychological, economic and political factors that place women at increased risk for acquiring the virus. As an example, when programs such as those related to the prevention of mother-to-child transmission of the virus are implemented, the policy framework is often limited to the prevention of transmission of the virus to the baby. There is often less attention paid to the equally compelling need to prevent HIV-related severe morbidity and mortality in the women themselves. To date, there is evidence that HIV/AIDS is the leading cause of maternal mortality among pregnant women in some parts of Nigeria3. Yet, there has been no systematic plan of action to develop women-centered and gendersensitive HIV/AIDS programs that reduce death and severe morbidity in women.
Two articles in this edition of the journal provide examples of how programs can be rationalized and specifically designed for the prevention and treatment of HIV/AIDS among vulnerable women. The paper by Holstad et al4, report the use of motivational interviewing to increase adherence to anti-retroviral treatment and increased use of risk reduction behavior among Nigerian women living with HIV/AIDS. This method is novel and has the intended purpose of alleviating the psycho-social and attitudinal barriers that often prevent women from accessing anti-retroviral treatment as well as follow-up preventative plan. The second paper by Hembah-Hilekaan et al5 reports the results of a cross-sectional survey in Benue State (the region with one of the highest prevalence rate of HIV/AIDS in Nigeria) that investigated the factors limiting the access of pregnant women to prevention and treatment of HIV/AIDS and the prevention of mother-to-child transmission of the virus. Some of the barriers identified included women’s lack of knowledge about treatment and prevention services, their fear of stigmatization and the negative attitude of health-care providers. The authors recommend specific interventions based on integrated services, specific health workers training and re-training and community engagement for increasing women’s access to HIV prevention and care services during pregnancy. Together, both papers speak to the need to target HIV/AIDS prevention and curative programs to address the specific concerns of all categories of women.

Clearly, the need to prioritize the design of programs specifically targeting women for the prevention and treatment of HIV/AIDS in the African region is urgent. It will contribute towards alleviating the burden of the disease, especially the attainment of MDG-6 and other health-related MDGs, and will alleviate the relative social injustice experienced by women suffering from the disease. In Swaziland, current estimates indicate that HIV prevalence among pregnant women is extremely high, with up to 40 percent of women infected. Despite the declines that have occurred in HIV prevalence among antenatal clinic attendees in countries such as Burkina Faso, Burundi, Kenya, Zimbabwe and Uganda, recent reports that suggest that a country like Senegal that previously had low rate is now witnessing increased prevalence among pregnant women is certainly a cause for concern. It indicates that unless the specific needs of women are addressed in a holistic and purposeful manner, even the little pockets of progress that have been made will not be sustained. HIV prevention and care programs that target women should be comprehensive and broad-based and should address the systemic factors that increase women’s vulnerability and that prevent them from accessing appropriate evidence-based information and services for the prevention and treatment of the disease.