Women with HIV/AIDS in Sub-Saharan AfricaSarah Bransford, Love Odetola, Laurel Oswald,

Erick Marigi, Jack Schechinger

The Problem

Aids Fact Sheet

• Sub-Saharan Africa Population: 926,000,000 people

• People living with HIV/AIDS: 25,000,000 peopleo 69% of the worlds HIV/AIDS carriers live in SSA

• Women (aged 15+) with HIV/AIDS: 14,750,000 peopleo 59% of carriers, and 70% of young people carriers

• Children with HIV/AIDS : 2,900,000 people• AIDS deaths in 2012: 1,200,000 people

* All stats are as of 2012 and newer from UNAIDS

Biological ReasonsTransmission from man to woman is easier• larger area of vaginal epithelium • transmission of larger volume of genital

fluids --higher viral load in semenMalaria increases HIV infection• increases viral load 7-10x

Biological ReasonsParasites• deplete nutrients through

intestinal loss and chronic diarrhea

Schistosomiasis• worms in lakes and streams • produces genital lesions

Malnutrition • Increases susceptibility to

HIV by lowering immune function

• 19 of the 21 worldwide famines

• Females more vulnerable

• deficiencies in macro (proteins) and micronutrients (vitamins)

• Higher risk of infection

• Food insecurity o More likely to engage in

risky sexual practiceso Sex as a means for

money o Worry over food,

inadequate quality, inadequate quantity, or acquired through socially unacceptable means

Malnutrition

Low Socioeconomic Status

• Associated with a higher risk of HIV in women • Studies show riskier sexual behavior • Lack of safe transportation to and from school • Wealth correlated with increase in risk for both

sexes o Poverty disproportionately increase risk for women

• South African Study o Low income households

associated with earlier loss of virginity

o High probability first encounter forced

o Increased rates of transactional sex

Low Socioeconomic Status

Education● According to the World Bank

17.4 million girls are not enrolled in primary school compared to 14.8 million boys in Sub Saharan Africa

● Why do girls drop out?○ Typically poor ○ Fall behind during menstruation○ Gender inequality○ Rural communities

Education Implications

● Higher education in girls & women leads to increased:○ Age of first sexual

encounter○ Condom use○ Family Planning○ One sexual partner

Gender InequalityMen hold the power in Sub Saharan Africa:

● Economic: Bride payments or economic inferiority

● Social: Men often have multiple partners

● Sexual: Men often make the final decisions about family planning

War - HIV & Maternal Health• Rwanda (1994): 200,000 - 500,000 rapes

• UNICEF: 80% HIV positive among female rape victims

• Rape: Increases risk of HIV infection

• High HIV prevalence population mix with low prevalence population!

Intimate Partner Violence and HIV• 40% - 45% of violent

relationships include forced sex.

• Forced sex -> Vaginal/Rectal lacerations that increase likelihood of HIV transmission.

• Rape increases women's HIV risk infection by 30%.

Intimate Partner Violence and HIV

• Ex: Tanzanian men who act violently in relations are 1.8X more like to have pre/extramarital sex.

• Leads to more HIV transmission.

• Abused women: decreased immune system.

Millennium Development Goal 55A: Reduce by three quarters the maternal mortality ratio

5B: Achieve universal access to reproductive health

Case of Eritrea-Once had highest maternal mortality rates (1,400 deaths per 100,000 births)

-One of four African countries on track with Millennium Development Goal 5

-each community now has trained maternal caregivers who visit homes

Recap• Question: Why are women more predisposed to

contract HIV/AIDS in Sub-Saharan Africa

o Biological Reasons

o Conflict and War

o Gender Inequality and Education

o Malnutrition and Socioeconomic status

Sub-Saharan Africa AIDS Challenges

1. National and community development

2. Enabling individuals to protect themselves

3. Providing health care and treatment

Picture of Chief Chikanta at a voluntary counseling and testing (VCT) sign in Zambia

*http://www.avert.org/images/5165-chief-chikanta-vct-sign-zambia

National and Community Development

• Impact of HIV/AIDS on a countryo Strains health sectors - resources and financeso Affects labor- most HIV/Aids affected are in working primeo Significantly slows down economic growth and development

• Progresso Increasing international and requiring domestic funding

developing infrastructure, promoting self sufficiencyo Focusing on women with HIV

Microbide treatments, and educationo Reducing HIV-related stigma and discrimination

Self protection from HIV/AIDS• Prevention is the goal• Condoms

o Cheap and cost effectiveo Social, cultural, and practical

(pregnancy) factors deter use

Message from BVI Nurses Association about HIV prevention http://www.avert.org/hiv-and-aids-africa.htm#sthash.oQ6hGMQR.dpuf

• HIV Testingo Provision of voluntary HIV counseling and

testing (VCT) programo Rapid HIV testing

same day test and diagnosis

Providing health care and treatment• Antiretroviral drugs (ARVs)

o delay the progression of HIV to AIDS o Distribution of ARVs require money, health systems, and workers

• Problemso Access to care, for many Africans with HIV, ARVs are not availableo Children with HIV are less likely to receive ARvs than adults (21%)o Poor healthcare infrastructure and lack of and funding

• Progresso Notable increase in ARV access 49% in 2010 -> 56% in 2011 o Treatment offered for opportunistic infectionso Aids Treatment Video

Connection to class content

Crisis vs. Protracted Crisis“In war, or natural disaster, humanitarian medicine intervenes to minimize the effect of the crisis on human health through medical intervention.”

Acute crisis“the best we can possibly do”

Should we consider HIV a worldwide neglected emergency?