The good news in “Maternal mortality for 181 countries, 1980 – 2008″[i] is that worldwide deaths related to reproduction fell by one-third over the period studied. But that is tempered by bad news emerging from southern and eastern Africa: in the region of the world most heavily affected by the AIDS pandemic, HIV has not only blocked progress toward maternal health, but is responsible for an additional 61,000 maternal deaths per year.
AIDS-Free World and the International Treatment Preparedness Coalition are relieved that scientific researchers have finally calculated the deadly consequences of ignoring the link between HIV and maternal mortality – a link long evident to AIDS and women’s rights activists, but entirely missing from international goals. We call on WHO, UNAIDS and all international and national AIDS programmers to waste not another moment before applying the data to new programmes that will view pregnant women with HIV as a high-risk group, as worthy of treatment and care as any other.
Currently, global AIDS programmes are reminiscent of the Victorian era, casting pregnant women as potential vectors of disease, and ignoring their health in the single-minded rush to achieve a 2010 goal of preventing the transmission of HIV to their babies.
The only global target that refers at all to HIV-positive women during pregnancy, childbirth and the weeks immediately following is focused exclusively on healthy outcomes for infants. The programme’s name – “Prevention of Mother-to-Child Transmission” – describes its singular, narrow purpose. The global target of “reducing the proportion of infants infected with HIV …by 50% by the year 2010” makes no mention of the high risks of mortality to HIV-positive pregnant women.
While it is standard for pregnant women in the West to receive HIV treatment as both mothers-to-be and patients, it is rare for an HIV-positive woman at an antenatal clinic in eastern or southern Africa to be assessed and prescribed drugs for the management of her own HIV. Most are treated only to reduce the likelihood that their babies will contract the virus, and are discharged without a clinical assessment of their own health after giving birth. Far too many – without their full knowledge of the risks to themselves – are prescribed a single dose of nevirapine, best known as part of the “cocktail” of three drugs that makes up initial anti-retroviral therapy for many HIV patients worldwide. While one dose of nevirapine each to mother and newborn will reduce the chance that the baby will contract HIV, nevirapine administered alone in this way can also cause the mother’s HIV to resist future treatment with anti-retroviral therapies containing nevirapine, putting her life at risk.
The lesson of this latest good news/ bad news research is abundantly clear: we have long known that women living in countries heavily affected by HIV are at very high risk of infection; we now know that infected pregnant woman are at increased risk of death. By retaining global AIDS goals, targets, policies and programmes that ignore those undeniable facts, AIDS policy makers and programmers will persist in the neglect of women and the endangerment of pregnant women’s lives.
Gregg Gonsalves, International Treatment Preparedness Coalition
1 (203) 606-9149