According to data from the Global Burden of Disease Study, in 2015, HIV and AIDS was the leading cause of death among women of reproductive age around the world. While estimates differ depending on the particular global context, a 2013 review concluded that approximately 5% of pregnancy-related deaths worldwide and 25% of pregnancy-related deaths in sub-Saharan Africa are attributable to HIV and AIDS. Women living with HIV and AIDS in sub-Saharan Africa are at 6-8 times greater risk of dying during pregnancy or postpartum than their HIV-negative peers.
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 and to developing active tuberculosis, which are associated with increased risk of maternal death. A review of 44 studies found that HIV-positive status was associated with increased risk of intrauterine infection, puerperal sepsis, antepartum hemorrhage, uterine rupture and prolonged labor. Additionally, proactive measures must be taken to prevent vertical transmission of HIV from infected 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. For example, for many women around the world, antenatal care is their first adult contact with the health care system, representing 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 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; apprehension about HIV-status disclosure; and lack of social support from partners and family. 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 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.