The Maternal Health Task Force (MHTF) is pleased to announce the publication of a themed supplement to the Journal of Acquired Immune Deficiency Syndromes (JAIDS) focused on the critical intersections between HIV, reproductive, and maternal health services in sub-Saharan Africa. The creation of the supplement was led by Dr. Tamil Kendall of the MHTF and co-edited by four researchers at the Harvard School of Public Health.
This supplement is critical as 90% of pregnancies among HIV-positive women globally occur in sub-Saharan Africa. While we often speak of the importance of well-integrated HIV, reproductive, and maternal health care for the prevention of mother to child transmission (PMTCT), less attention is given to the impact of timely access to antiretroviral therapy (ART) on the life of the pregnant woman: the risk of maternal mortality is 6-8 times higher for a woman with HIV than an HIV-negative woman.
Recognizing the need and potential synergy of well-integrated HIV, reproductive, and maternal health care on a woman’s health, the MHTF, along with the United States Agency for International Development and the Centers for Disease Control and Prevention, convened global leaders in June 2013 for the technical meeting Maternal Health, HIV and AIDS: Examining Research through a Programmatic Lens, where participants identified specific gaps in research and practice. This supplement is an extension of and response to the topics addressed at the meeting as it 1) provides empirical evidence of the challenges to integrating HIV/AIDS, reproductive, and maternal health care; 2) describes how interventions and factors at the individual, health systems, and societal levels can affect women’s health outcomes; and 3) provides guidance for future research.
“The articles in the supplement can be used as a road map for research and practice,” said Kendall. “They provide useful empirical evidence for policymakers and practitioners to be able to take those next steps toward integration—and to evaluate those next steps—so we can continue to learn from what’s happening on the ground.” (HSPH)
While the supplement reflects the importance of integrated policy frameworks and approaches, in order to truly address the complex needs of women living with or at risk of becoming infected with HIV, quality comprehensive women’s health care must be provided. The supplement presents evidence and recommendations on three levels:
- Individual – clinical care and health outcomes
- Health system – synergies and challenges at multiple levels of the health system
- Societal – stigma and the social climate that either empowers or prevents women’s access to both essential HIV and reproductive health services
A summary of the evidence in the supplement shows that, at the individual level, when assessing levels of depression, prevalence is similar among HIV-positive women during both the non-pregnancy and postpartum periods, but women who had more time on ART, viral suppression, and better overall health had less severe depressive symptoms. This holistic assessment of mental health emphasizes the need for comprehensive health care for women, and not siloed efforts to address their health needs.
The scale-up of Option B+ (initiation of lifelong ART treatment for pregnant women despite viral load) is an excellent example of both success and health systems challenges to comprehensive women’s health care. While Option B+ led to a dramatic increase in the proportion of pregnant and breastfeeding women on ART, it also has created significant demands on the health system and some women are adverse to lifelong treatment. Addressing the complex needs of the health system for comprehensive women’s health can help mitigate some of these challenges.
Lastly, social constructs have a tremendous impact on an HIV-positive women’s health. For example, if a woman discloses her HIV status to anyone, it significantly increases her probability of delivering in a health facility and adhering to ART.
While the supplement provides a generous overview of the current evidence, large knowledge gaps still exist. Importantly, a large gap still remains on causes of maternal morbidity and mortality among HIV-positive women and on successful models for integrating HIV, reproductive, and maternal health. Continued policy, research, and programmatic efforts are needed to create comprehensive women’s health care for better outcomes and a healthier population.
Read more on this publication from the Harvard School of Public Health News.