Inter Press Service - March 30, 2000
Brian Kenety

For Lieve Fransen, these statistics underscore a woeful lack of understanding - or even denial - among leaders that fighting the spread of AIDS is a central development issue and that the plight of HIV-positive women and their children has been pushed aside.

Fransen is a member of the steering committee of the Group of Ghent. This was established in 1989 under the auspices of the European Union's executive Commission to bring together researchers and policymakers to tackle this and related problems.

The forum is a collaborative effort between developing and industrialised countries.

On Tuesday Fransen outlined the central points of the Commission's forthcoming book, 'Mothers and Children Confronting HIV' scheduled for publication in April, before a discussion group at the European Parliament. The book documents the research and policy formulation of the Group of Ghent between 1989 and 1999.

With respect to HIV, "women are the forgotten half," said Fransen. She said the new infections are most often found in women aged 15-24 and many of them contract HIV from their first sexual experiences, which are often coerced. The vast majority of cases occur in sub-Saharan Africa, where the overall infant mortality rate is 12 times that of the industrialised countries.

The maternal mortality rate is 61 times that of developed countries: of the nearly 600,000 women who die each year from complications of pregnancy or childbirth, 98 percent of them live in the developing world.

Olive Shisana, Executive Director of Family and Community Health with the World Health Organisation (WHO), gave a presentation on maternal mortality. Shisana said research has shown that poverty and underdevelopment are major factors in maternal mortality and that maternal deaths are closely associated with the level of education that a woman has received.

The presence of a skilled attendant at birth is also recognised as one of the most important interventions to make pregnancy safer.

On the whole, said Shisana, sexually transmitted infections (STIs), have been a neglected area in public health in most of the developing countries, despite overwhelming evidence of their impact on health, particularly for women and newborn babies.

In parts of Africa, the prevalence of HIV in pregnant women is over 30 percent while rates of new infection are rising in south east Asia as well as in many developed countries.

Shisana noted that whilst antiretroviral treatment to reduce mother-to-child transmission, or vertical transmission, of HIV is available, it is unaffordable for many women in developing countries.

"We shouldn't forget the consequences of mothers being pregnant with HIV and transmitting to their child ... some 11 million children are orphans, having lost one or both parents to HIV -- that is crying (out) for a developmental solution," said Fransen.

While in developed countries an infant's risk of acquiring HIV from the mother has been greatly reduced by sophisticated interventions, in the developing world far fewer diagnostic and care options are available due to a lack of infrastructure and high costs.

Women of childbearing age constitute nearly half of the 30 million adults currently living with HIV/AIDS worldwide.

Mother-to-child transmission of HIV during pregnancy is the major mode of acquisition for young children, with an estimated 1600 of the 16,000 new infections each day, through pregnancy, delivery or breastfeeding.

"So, where are we today? Ten years ago, we had no solutions. Now we know the whole situation of the transmission," said Fransen.

"(However) I am not impressed by any serious actions, programmes or preventions in most of the countries which focus on young women before they get pregnant." She said women need to be empowered through information and education.

"We have to develop systems to protect young women through societal changes and (modifying) their own behaviour, but also through the development of microbisicides and vaccines - that are under women's own control," said Fransen.

The Commission notes that the increasing number of HIV-infected women and children has implications for both the organisation of equitable and sustainable healthcare and the prevention of HIV vertical transmission.

The first step is to prevent the spread of HIV, next to test young women, so as to prevent HIV-positive women from unknowingly putting the unborn child at risk, and third to prevent mother-to- child transmission via breastfeeding, said Fransen.

WHO is working with governments and the international community to achieve the global commitment of a 75 percent reduction of the 1995 maternal mortality rate by the year 2015.

This target was agreed at the International Conference on Population and Development (ICPD) + 5 meeting in June 1999.

Shisana said that in the first year of the WHO's 'Making Pregnancy Safer' programme, the organisation planned to work in 10 high-risk countries, 20 in the second year, and in a total of 50 countries by the fifth year.

The first group of countries that has agreed to participate includes Ethiopia, Bolivia, Mauritania, Sudan, Mozambique, Moldova, Nigeria, Indonesia, Uganda, and Laos. Negotiations are underway with Nepal and Yemen.

Through this programme, the WHO hopes to be able to focus on improving access to quality maternal and neonatal health services for poor and vulnerable women and babies in 50 priority countries over a six-year period.

For this to be realised, Shisana said "most importantly, the governments themselves must be in the drivers' seats", that is, there must be an agreed health-sector strategy in each country under the programme.

The World Bank has indicated its willingness to provide lending to those countries undergoing health-sector reform which have a co- ordinated national plan of action to reduce maternal and perinatal ill health, involving the key multilateral and bilateral agencies, non-governmental organisations and the private sector.(END/IPS/bk/sm/00)
000330
IP000307

Always watch for outdated information. This article first appeared in 2000. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2000. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .