Delivering for Women and Children in South Africa
June 9, 2010
Addressing HIV is key to improving maternal and child health in South Africa
, according to a presentation given today by Dr. Kuku Appiah – the Foundation’s South Africa country director – at the Women Deliver conference
. She spoke today on a panel
advocating a family-centered approach to preventing mother-to-child transmission (PMTCT) of HIV, along with representatives from UNAIDS, UNICEF, ICAP, and Mothers-2-Mothers.
A native of Ghana, Appiah has lived and worked as a medical doctor in South Africa for two decades, and has witnessed the epidemic grow to massive proportions.
Today, South Africa has the world's largest population of people living with HIV – an estimated 5.7 million, with women and children disproportionately affected. In 2008, for example, more than 29 percent of women who visited an antenatal clinic were found to be HIV-positive.
In some regions, the numbers are even more severe. In one district where the Foundation works, more than 45 percent of women coming for antenatal care tested positive – meaning that almost one out of every two pregnant women in that area is living with the virus. This makes the Foundation’s work to protect the health of mothers and to prevent transmission of HIV to their infants all the more critical.
In circumstances like these, it becomes clear that maternal and child health and HIV services are inextricably linked.
“Provision of PMTCT services in the antenatal clinics is really talking about providing maternal and child services,” said Appiah. “They are not siloed. Any intervention taken in those facilities will have impact on maternal and child survival.”
Appiah used South Africa as an example of how political leadership can be the determining factor in whether efforts to prevent new pediatric infections are successful or not. Earlier in the decade, there was a distinct lack of political will to implement widespread HIV services in South Africa. The nation’s PMTCT program was actually the result of a 2001 constitutional court order brought about by a lawsuit against the Ministry of Health by an activist organization.
Ten years later, a change in political leadership and attitudes has yielded dramatic results.
“There has been a massive turnaround in political will, and PMTCT has been raised to the highest level of the national health agenda,” said Appiah.
South Africa has accelerated the scale-up of PMTCT in 18 districts hardest hit by HIV, while also improving the quality of services and aiming to expand efforts throughout the country.
On the ground level, community health workers have mobilized, going door-to-door to provide information about HIV as part of a national testing campaign. New advertisements and messaging campaigns on TV and radio are also spreading the word. One TV ad
targets men in particular, encouraging them to take responsibility for HIV prevention for themselves and their loved ones. Men are often key decision-makers in determining whether female partners access PMTCT services, affecting the health of both mother and child.
As a result of these efforts, communities have become more involved in PMTCT programs, according to Appiah. This type of community engagement is not accidental, but actually required and written into the national guidelines and policy in South Africa. It is particularly critical that communities mobilize to address a number of challenges, such as encouraging women to attend antenatal clinics earlier in their pregnancies to test for HIV, and reducing stigma over breastfeeding choices of HIV-positive mothers.
“We will need a sustained and integrated response to implementation challenges if we are to reach our PMTCT goals,” said Appiah. “But the elimination of pediatric HIV and AIDS can be a reality in South Africa, because of the political support and the platform we have to work on.”
Robert Yule is the Foundation’s Media Manager in Washington, D.C.