Maternal Health, HIV and AIDS

• Resources
• The Role of the MHTF

According to the 2020 UNAIDS Report, HIV and AIDS were the leading causes of death among women of reproductive age around the world. Every week, around 6,000 women aged 15 to 24 years acquire HIV. While estimates differ depending on particular global contexts, HIV treatment has been scaled up in the past decades; by mid-2019 there were more than 24 million people living with HIV on treatment, including at least 13 million women aged 15 years and over. Women and girls in sub-Saharan Africa, the world’s region with the largest HIV epidemics, are particularly affected: in 2018, women accounted for 59% of new infections among adults over 15 years in the region, and figures have remained unchanged since 1995.

HIV and AIDS influences the risk of maternal death through a variety of mechanisms. Pregnancy and HIV and AIDS both increase women’s susceptibility to acquiring malaria, with potentially serious drug interactions that hamper effective treatment for both infections. Having an HIV-positive status is associated with negative health outcomes, including increased risk of intrauterine infection. Additionally, proactive measures must be taken to prevent vertical transmission of HIV from mothers to their babies during pregnancy, delivery and breastfeeding.

While progress has been made towards increasing HIV-testing during pregnancy and providing antiretroviral therapy (ART) to prevent vertical mother-to-child transmission, insufficient integration of HIV services into reproductive, maternal, newborn, child and adolescent health care is a major challenge. Pregnancy is a timely opportunity to engage women with needed services for their health and that of their unborn child. Yet the costs of antenatal care and delivery services can prevent expecting mothers from seeking this care. Across Africa, Asia, Latin America and the Caribbean, more than 5 million families spend over 40% of their household expenses on maternal health services every year. Antenatal care represents an important opportunity to screen for, prevent and treat chronic diseases such as HIV and AIDS; however, many women who test positive for HIV during pregnancy do not receive the follow-up care that they need.

Documented barriers to women beginning and continuing HIV treatment include parental consent for adolescent girls; a lack of knowledge about the benefits of ART; psychological factors such as shock, denial and fear of treatment or side effects; financial constraints; HIV and AIDS-related stigma, discrimination, or violence; apprehension about HIV-status disclosure; lack of social support from partners and family; and judgmental encounters with healthcare providers. Broader health system issues such as poor quality of care and social determinants including geographic and economic barriers are also associated with poor uptake and retention.

Reducing HIV and AIDS-related stigma and gender discrimination, including violence against women, increasing family and social support for HIV-positive women during and after pregnancy, training healthcare providers to provide nonjudgmental, compassionate care, and mobilizing communities to promote respectful, high quality, integrated HIV and maternal newborn health services are promising strategies for preventing maternal deaths caused by HIV and AIDS.