Thursday, November 11, 2010

Would You Risk HIV While Pregnant or When Planning a Family?

South African's City Press has an article entitled 'Survey finds staggering HIV rate in pregnant women'. And the figures are, indeed, staggering. National prevalence among pregnant women is almost 30%. Rates have been stable for several years and the health minister wishes to see prevalence decrease to 17.3% by 2015. Of course, this is unlikely unless death rates reach equally spectacular levels.

But what is really staggering is how one could believe that so many women who intend to have children or who are already pregnant would risk contracting HIV and possibly passing it on to their child, in addition to having to live with a life-threatening disease themselves. Doesn't that strike anyone as odd?

Many African women are infected when they are already pregnant, often well into their pregnancy. Are we supposed to believe that so many people wish to have a child but don't really care whether that child will live or whether the child will lead a healthy life?

Frankly, I don't believe that South Africa, or any other country in the world, is populated by so many people who don't care whether they or future generations continue to suffer from this terrible pandemic, which is hundreds of times worse in some sub-Saharan African countries than it is anywhere else.

Try thinking about it: you want to get pregnant or you are already pregnant, intentionally or otherwise; and you take many risks and no precautions towards ensuring your own safety or the safety of your child. This would require total ignorance or total heartlessness. Are we seriously suggesting that so many people in South Africa are either ignorant, heartless or both?

Transmission rates among pregnant women in South Africa and other African countries cannot be explained by sexual behavior, no matter how much sex people are having and no matter how 'unsafe' it is. These rates could only be explained by some efficient mode of transmission, such as nosocomial transmission. This is where the disease is transmitted through unsafe medical practices.

I have mentioned it before but it's worth repeating: the WHO estimates that 70% of medical injections in sub-Saharan African countries are unnecessary. And almost 20% of injections are unsafe.

Pregnant women attending ante-natal clinics in African countries get a lot of injections. Often, their babies also get a lot of injections. There is ample opportunity for high rates of transmission in countries where HIV prevalence is high and safety standards are low.

To believe that HIV is being sexually transmitted among pregnant women at such high rates is to believe appalling things about African women (and probably men, too). In short, to believe such things is to be a racist, a sexist and probably much else that's not very pleasant.

Not only do Africans behave sexually much like other human beings, they also place value on human life, especially their own and those of their children. Just what are those who believe HIV is almost entirely sexually transmitted in African countries trying to say about Africans?



Simon said...

Apparently the highest rates of infection are in 30-34 year old pregnant women so many of them are likely to have been pregnant before.

Even less credible, then, that they would risk HIV infection while pregnant and already responsible for a family.

Anonymous said...

Do you think it might just be because the actual HIV AIDS rate is that high but that pregnant women that go to the hospital just get tested, while all the other women/men do not as there is no reason for them to take the test.

I wonder if you tested everyone in the country, pregnant or not, if you would get the same prevalence rate.


Simon said...

Hi Silvia
Good question, but unfortunately the answer is generally no, population surveys show that HIV rates are far higher among women than men.

Some say that's because women are more susceptible, which may be true, but that doesn't answer the question of how they are positive when their partner is not.

In the Luhya tribe in Western Kenya, there are 10 HIV positive women for ever 1.7 HIV positive men. Surely no one would suggest that most pregnant women sleep with this small number of men!

The frustrating thing about a lot of testing programs, though, is that they make little or no effort to find out how people are infected, it is just assumed (in African countries) that they were infected sexually.

It may seem obvious that a woman who is pregnant has been having unprotected sex. But is her partner infected? If not, as is often the case, how did she become infected? This needs to be investigated.

Many infants and babies and children are testing positive when their mothers are just assumed to be positive, but not always tested. Even if the mother is positive, this doesn't mean she infected her child. The child could easily have been infected by some medical procedure.

Genetic typing can establish if they both have the same strain of HIV but this is rarely carried out in African countries, where HIV rates are highest and medical facilities are worst.

No, there seems to be something about getting pregnant and HIV infection. Lots of people are having sex, protected or otherwise, but getting pregnant is playing Russian Roulette at the moment.

Pregnant women may be more susceptible too, but this needs to be investigated, given the relatively low numbers of HIV positive men in some areas.