The past fifteen years have shown major improvements in ending the AIDS epidemic globally: the number of people newly infected by HIV has declined by 38 percent since 2001 and AIDS related deaths have fallen by 35 percent since 2005.
However, these promising statistics mean little for a woman in Uganda who has just passed on HIV to her newborn baby. Every year, roughly 1.5 million HIV positive women become pregnant and 90 percent of all HIV infections in infants and children are a result of mother-to-child transmission of the virus.
Thankfully, there are highly effective prevention of mother-to-child transmission (PMTCT) strategies that can reduce the likelihood of passing along the virus to a baby from 15-45 percent to less than 5 percent. Unfortunately, these advancements are not yet equitably shared around the world, with almost all new infections of HIV in infants and children occurring in sub-Saharan Africa.
Barbara Bush is CEO and co-founder of Global Health Corps (GHC), an organization that mobilizes a global community of young leaders to build the movement for health equity. Barbara co-founded GHC in 2009 in response to the health disparities she witnessed when traveling to East Africa during the launch of the President’s Emergency Plan for AIDS Relief (PEPFAR). With the support of partners like Johnson & Johnson, GHC has placed 450 young leaders in high-impact fellowships focused on health issues ranging from HIV/AIDS to diabetes to maternal and child health.
Barbara interviewed one of GHC’s alumni from Uganda, Brian Ssennoga, who spent the last year as a GHC fellow working to prevent mother-to-child transmission of HIV/AIDS. Brian is optimistic about an AIDS-free generation, but his first-hand experience showed him that this cannot be done without the investment of men in women’s maternal and reproductive health.
BB: Brian, can you tell us a bit about the work you did as a GHC fellow in Uganda?
BS: I was placed at The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), whose mission is to eliminate pediatric HIV infections through research, programs, and advocacy and public policy. I was charged with sharing the stories of people affected by HIV; I saw the story of HIV transform, from one of a wasted victim on a hospital bed, to one of hope in which hundreds of babies are born free of HIV due to strategic interventions. One of the most important lessons for me was how a man’s involvement can play a significant role in helping prevent the transmission of HIV to infants and children.
BB: You’re right; male involvement in PMTCT is critical. What does this look like in Uganda?
BS: Correctly following PMTCT guidelines is essential for ensuring HIV-negative babies, but there are a number of challenges to doing so. For example, for the programs to work, pregnant women need to attend all four of their antenatal check-ups. Most women in remote villages in Uganda need financial support, permission from their male partners, and transportation to go to the health facilities for the check-ups. We are seeing a disturbing trend where decreasing numbers of mothers show up to each subsequent check-up; this needs to be reversed, and men should rise up to support their partners in this regard.
BB: In your experience, what does typical male involvement look like in Uganda?
BS: Unfortunately, men are often not included in the maternal and reproductive healthcare of their partners, either by their own choice or because providers in the community do not expect them to be involved. For example, a man might accompany his wife to a hospital in Kampala for an antenatal care visit, but he will likely spend hours in the reception area watching TV.
But this has to change – and it is changing. One exciting innovation we’ve seen is in Isingiro District, where a health facility has started to offer incentives to female clients who come with a male partner if they have one. In a month’s time, the rate of male attendance rose.
BB: How else can we engage men to ensure they are invested in the sexual and reproductive health of women and their babies?
BS: One solution I think we should pioneer is a “Men’s PMTCT Package” – a collection of services and activities geared towards men who support and escort their HIV-positive pregnant partners. Men who follow the program should be rewarded with incentives to encourage other men to follow suit.
We also need to disseminate this knowledge to the broader population. There are already efforts in place supported by UNICEF and EGPAF to engage leaders in south-western Uganda in this type of discussion. We need to get the conversation onto the street and into schools to target young men and ensure that the next generation is born HIV-free.
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