Running Head: AIDS & HIV Positive Pregnant Women in Africa and or Sub-Saharan

Africa
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AIDS & HIV Positive Pregnant Women in Africa and or Sub-Saharan Africa

Brandee M. King

Professor Kathy S. Faw RN, MSN

Bon Secours Memorial College of Nursing

NUR 3113

April 7, 2017

Honor Code “I pledge..”

 AIDS & HIV Positive Pregnant Women in Africa and or Sub-Saharan Africa
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AIDS & HIV Positive Pregnant Women in Africa and or Sub-Saharan Africa

The number of women in South Africa accounts for approximately 30% of the

population, which is roughly 280,000 women each year (Burton, Giddy & Stinson, 2015). The

original goal for the prevention of HIV/AIDS in Africa was to prevent vertical transmission, but

the concern for that was senseless once determined that women who tested positive for HIV in

pregnancy knew they were unlikely to stay alive to see their children grow up. Today, it is

estimated that there are over 2.4 million orphans with AIDS in South Africa (Burton et al.,

2015). The impact of HIV infection on maternal mortality continues to be overwhelming and

undoubtedly underestimated, but with changing technology and the incorporation of the

Millennium Development Goals, the overarching goal is to eliminate the spread of HIV infection

among women and prevent prevention from mother to child.

Social Determinants of Health

The AIDS and HIV epidemic in Africa is difficult to address because the causes are

widespread and vary based on time. According to the BMC Journal on Infectious Diseases, most

HIV transmission in sub-Saharan Africa is primarily through heterosexual intercourse but the

main cause of transmission is the act of having unprotected sex with an infected person. There is

a strong correlation between increased number of sexual partners, and increased risk of

transmission (Zulu, Kalipeni & Johannes, 2014). Even though the primary cause of HIV/AIDS

transmission in Africa is known, recent research suggests that other factors come into play such

as socioeconomic status, demographics, cultural, historical, and geographic factors and their

configurations affect the vulnerability to this particular population (Zulu et al., 2014).

Underlying factors include high levels of poverty, low literacy, high rates of unprotected casual

and transactional sex, low male and female condom use, and cultural and religious factors.
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Poverty was closely studied where it revealed that those who do not have access to

prompt and sequential treatment increased the risk of HIV transmission 2-20 times per sexual

contact, particularly in curable sexually transmitted diseases (Zulu et al., 2014). Poverty in

Africa forces some women into commercial sex and other risky sexual behavior in order to

survive day to day, which in turn increases their risk of contracting and spreading HIV and

AIDS. Because of this, Africa has high unemployment rates and low wages thus leading to

behavior which may explain the prevalence of high HIV rates among the urban poor (Zulu et al.,

2014). Men are also at a high risk of HIV/AIDS because of economic conditions where

international male labor migration has resulted in the man being separated from their spouse for

extended periods of time, leading to casual sex and HIV infection among those in their area and

spouses upon return home (Zulu et al., 2014). Geographically, HIV/AIDS infection has been

associated with proximity to major transportation networks and to urban trading centers.

Evidence-based Interventions addressing Health Needs

One of the Millennium Development Goals is to combat HIV/AIDS, malaria and other

diseases. Target 1 of this goal was to have HIV/AIDS halted by 2015 and to reverse the spread.

One way the HIV/AIDS epidemic is being addressed is through PMTCT which is the prevention

of mother to child transmission. A constitutional court case in 2002 revealed that the lack of

resources and health care to mothers specifically was unconstitutional. From this particular court

case, plans for a national ART (antiretroviral therapy) program came about which, involved the

Department of Health and other medical experts (Burton et al., 2015). From these programs large

strides have been made. The WHO recommendations in 2013 changed, allowing pregnant

women to be eligible to initiate HAART which is a combination therapy of medication based on

the viral load in the blood. The DOH negotiated the lowest price in the world for drug therapy,
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making HAART cost effective and simple (Burton et al., 2015). The Western Cape provincial

guidelines stated that all pregnant and breastfeeding women would be eligible to continue

lifelong HAART. From these changes, maternal mortality from HIV has seen an overall

reduction by 13% with a 17.7% reduction from live births. Deaths from non-pregnancy related

infections remain the single highest but showed a 28% reduction in mortality among HIV-

positive women (Burton et al., 2015).

Another intervention involved in combating the HIV/AIDs epidemic among pregnant

women in Africa would be to address the education being provided to women who are at risk of

infection. Education that needs to be addressed includes condom use except during days with

peak fertility, vaginal self-examination specifically when the female is HIV positive, medically

assisted reproduction, screening and proper treatment of HIV/AIDs, and fertility screening to

prevent unnecessary HIV exposure during pregnancy attempts (Ngure, Kimenia, Dew, Njuguna,

Mugo, Celum, Baeten & Heffron, 2017). The Journal of International AIDS Society is

conducting a study that involves health care providers promoting safer conception through

delivering additional knowledge to women in Africa, specifically Kenya. One effort made was

providing cross-disciplinary training to the health care providers in Africa that would equip

providers with the knowledge needed to offer couples a more comprehensive and safer

conception package that would include ARTs as well as fertility counseling (Ngure et al., 2017).

Global Approach in Addressing “Health for All”

According to our text, “Globalization is a term used to refer to the increasing economic,

political, social, technological, and intellectual interconnectedness of the world” (Anderson &

McFarlane, 2015). The defining factor of global health is that it transcends national borders and

it involves the spread of infectious diseases across the world (Faw, 2017).
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One way to address health for all would be family counseling and postnatal services

offered to women to reduce the likely spread of HIV but also offer HIV treatment at that time.

While also considering the need for family counseling and postnatal care, it is important to

consider the need for the male partner to receive HIV treatment along with education on safe sex

and the need to wear a condom during intercourse (Kimani, Warren, Abuya, Ndwiga, Mayhew,

Vassall, & Askew, 2015).

By increasing male involvement in HIV related pregnancies we can also attempt to

reduce the spread of infection through many sexual partners. The idea behind involving the male

partner in pregnancies is designed to enhance sexual communication and HIV knowledge,

increase safe sex, and encourage HIV testing and mutual disclosure of HIV status to sexual

partners (Jones, Peltzer, Vallar-Loubet, Shikwane, Cook, Vamos, & Weiss, 2013). According to

a study conducted and published by AIDS Care, HIV transmission during pregnancy exceeds

that of non-pregnant couples. By promoting the involvement of the male partner in sexual

activity, you decrease the rate of risky behavior and increase the number of individuals who are

tested and treated for HIV so that they can disclose their infectious status to their partners. In

doing this we are aiming to prevent the spread of HIV/AIDs not only in Africa but also across

borders.

Conclusion

HIV/AIDS is the leading cause of adult death in Africa, with a steady decreasing rate

from a peak of 2.2 million in 2005 to an estimated 1.8 million in 2010. Many improvements have

been made including HIV testing and counseling uptake and increased access to ART therapy.

However, with new and developing improvements being made many people living with HIV in

low and middle income countries do not know their HIV status, specifically women (Anderson et
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al., 2015). It was also estimated in the 2012 MDG Report that only 48% of those needing

treatment were receiving it. From researching this topic, the role of nursing in global health is

clearly evident and still pertinent today. Being a patient advocate is a crucial part of being a

nurse and educating patients to the best of their ability. Through these efforts the goal is to

combat the HIV/AIDS epidemic in pregnant women with education and modern technologies to

prolong the lifespan for both a mother and child.

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References

Anderson, E. T., & McFarlane, J. M. (2015). Community as partner: Theory and practice in

nursing. Philadelphia: Wolters Kluwer Health.

Burton, R., Giddy, J., & Stinson, K. (2015). Prevention of mother-to-child transmission in South

Africa: an ever-changing landscape. Obstetric Medicine (1753-495X), 8(1), 5-12.

doi:10.1177/1753495X15570994

Faw, K.S., (2017). PowerPoint presentation on Global Health & Vulnerability. NUR 3113

Vulnerable Populations and Global Health, Bon Secours Memorial College of Nursing,

Richmond, VA.

Jones, D. L., Peltzer, K., Villar-Loubet, O., Shikwane, E., Cook, R., Vamos, S., & Weiss, S. M.

(2013). Reducing the risk of HIV infection during pregnancy among South African

women: A randomized controlled trial. AIDS Care, 25(6), 702-709.

doi:10.1080/09540121.2013.772280

Kimani, J., Warren, C. E., Abuya, T., Ndwiga, C., Mayhew, S., Vassall, A., & ... Askew, I.

(2015). Use of HIV counseling and testing and family planning services among

postpartum women in Kenya: a multicentre, non-randomised trial. BMC Women's Health,

151-11. doi:10.1186/s12905-015-0262-6

Ngure, K., Kimemia, G., Dew, K., Njuguna, N., Mugo, N., Celum, C., & ... Heffron, R. (2017).

Delivering safer conception services to HIV serodiscordant couples in Kenya:

perspectives from healthcare providers and HIV serodiscordant couples. Journal Of The

International AIDS Society, 2052-58. doi:10.7448/IAS.20.2.21309

Zulu, L. C., Kalipeni, E., & Johannes, E. (2014). Analyzing spatial clustering and the
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spatiotemporal nature and trends of HIV/AIDS prevalence using GIS: the case of

Malawi, 1994-2010. BMC Infectious Diseases, 14(1), 1-39. doi:10.1186/1471-2334-14-

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