What Works in HIV Prevention: Keeping Women and their Children Healthy

TORONTO, Canada — “AIDS is in the same league with the other big issues like global warming and poverty,” Dr. Peter Piot, Executive Director of UNAIDS said in a conference panel. “It is an exceptional problem that demands an exceptional response.”

The XVI International AIDS Conference was exceptional as well. Twenty-five thousand people representing nearly every country in the world participated. It was a place where one could find out about any aspect of the epidemic or response.

The energy and the sheer scale of the event were at times overwhelming: All day long, streams of people flowed up and down the escalators and skywalk that connected the six floors and two buildings of the convention centre. Finding a meeting room could become an adventure. The printed programme ran 500 pages and weighed in at a couple of pounds. The kick-off nearly filled the stadium next door.

If the experience was taxing for most people, it was especially difficult for people living with compromised immune systems. But their needs were not overlooked. Down one long hall, past the Internet café and the exhibition booths, they could find refuge from the noise and excitement and energy of the day’s events.

The lounge for people living with HIV and AIDS was an oasis of calm away from the crowds. Spaces were divided by long curtains. Low couches were draped with brocade cloths and cushions. Dimmed light coupled with soothing music and a bubbling fountain gave the room the feeling of a spa. Free massages were offered. Quiet spaces were available for prayer and meditation; privacy was afforded for those taking their medications. Nurses and wheelchairs were on hand.

People living with HIV have very special – but often overlooked – needs with regard to their reproductive health as well, says Steve Kraus, chief of the HIV/AIDS branch for UNFPA, especially given the feminization of the epidemic.

“The sexual and reproductive health needs for women living with HIV is gathering greater attention,” he says. “As their numbers increase, so does the need for services tailored to their needs – for family planning, safe delivery and for breastfeeding counselling.”

Most of these women don’t know they have the virus. Many will not have any symptoms for years. But they should be routinely offered voluntary testing and counselling when they come in for services such as pap smears and antenatal care, he said.

This kind of routine care would have helped Juliet Ajav-Nyior, who was a delegate to the conference from the Centre for the Right to Health in Nigeria. When she was pregnant five years ago, no one offered HIV testing during her prenatal care. After the birth of the child, her second, she diligently prolonged breastfeeding for two full years, thinking it was the right thing to do.

But it was at some point during those two years, she now believes, that her baby contracted the virus. Then she discovered that she and her husband were HIV positive as well. Both tested negative before their marriage and had no reason to think they were at risk.

“We don’t know how we got HIV,” she said. “Maybe we should have been tested a second time. But now HIV is here and we have to accept it, not blame one another.”

One of the most heartbreaking aspects of Juliet’s situation is that she could have kept her baby healthy if she had only received appropriate health care.

HIV-positive women have the right to protect their own health and the health of their families, Kraus said. But 90 per cent of people living with the virus do not know they are infected. Those who do know and want to avoid pregnancy often have no access to contraception. Services to prevent mother-to-child transmission reach fewer than 10 per cent of the women who need them, even though mothers-to-be are desperate to protect their unborn childen.

“The situation cries out for greater integration of HIV prevention with maternal health care,” Kraus said. “Even in resource-poor countries, most women get some form of maternal care. It’s a perfect point for HIV interventions.”

UNFPA is the lead agency within UNAIDS with responsibility for addressing the reproductive health and rights of this critical group, including their right to be sexually active and to bear children. And as treatment in some places is prolonging the lives of some people for decades, more and more HIV-positive women want to exercise this right.

“I’m 22 years old now,” said one young woman at the conference. “I was diagnosed when I was three. I’m in college. I date. I hope to marry and have children. My future is bright.”

— Janet Jense