Preventing Mother-To-Child Transmission of HIV/AIDs in South Africa
According to the World Health Organization (the WHO), approximately 39.9 million people were living with Human Immunodeficiency Virus (HIV/AIDs) at the end of 2023, 65% of whom were from the WHO Africa region. In South Africa, high HIV/AIDs prevalence and low testing and treatment rates suggest a history of high mother-to-child transmission of HIV/AIDs (MTCT, or vertical transmission), and high levels of maternal and infant mortality related to HIV/AIDs. A combination of cultural stigma and lack of access to healthcare resulted in circumstances where pregnant women and new mothers were not getting tested, diagnosed and informed about the treatment needed to stay alive and prevent MTCT. Today, South Africa has achieved the virtual elimination of MTCT.
Problem Statement
Preventable and high rates of vertical transmission of HIV/AIDs and subsequent increased infant and maternal mortality rates are caused by a lack of diagnosis and accessible treatment.
Context
Cultural stigma and lack of education or accurate public health information (i,e. pamphlets, infographics, and screenings) are preventing people from accessing, availing, or being made aware of care and treatment for HIV/AIDs. People fear being diagnosed with HIV/AIDs and being stigmatized and/or shunned by families and communities. Treatment and transmission prevention strategies are built on achieving viral suppression with antiretrovirals, as undetectable viral load renders the virus untransmittable (U=U).
The WHO “treatment as prevention,” strategy, communicated as 95-95-95, seeks to achieve a rate of 95% of people within a population aware of their HIV/AIDs status, at least 95% of those that test positive for HIV/AIDs to receive adequate treatment, and finally achieve a 95% rate of successful viral suppression. This strategy is key to eradicating the transmission of HIV/AIDs but is only achievable where testing, diagnosis and treatment options are widely available.
Factors within the Problem Situation
- Understaffing and underresourcing of healthcare facilities
- Stigma and a lack of education about HIV/AIDs acts as a barrier to health-seeking behavior and results in testing avoidance
- Inaccessibility or stockouts of testing and treatment commodities
Implementers/Actors/Stakeholders
- Community members: women with HIV/AIDs and their families
- South Africa Department of Health (DOH) at national, provincial and municipal levels
- Doctors, nurses, midwives, and community health workers (CHWs) caring for patients
- Nonprofits employing CHWs and providing public health support to the DOH
- International and domestic donors
- Mothers2mothers nonprofit organization
Intervention
Nonprofit organizations employ, train, supervise, and deploy a cadre of women with HIV/AIDs as paid Community Healthcare Workers (CHWs) who work in clinics and in the community to educate about HIV/AIDs and care and treatment programming, and provide psychosocial support. CHWs in the community, linked to clinics, support women and their families, drive uptake of care and treatment services, ensure treatment adherence, perform loss-to-follow work, and identify any at-risk individual for referral to clinics. CHWs serve as case managers, building trust and providing screening and referral services for women and families to a full range of healthcare services.
This CHW program creates a space for women community members to connect and consult with community leaders and other trusted organizations and use pre-existing communication networks to shift narratives about HIV/AIDs towards something more effective in combating the virus, especially when it comes to MTCT among pregnant women. This program also works to address staffing needs in underresourced healthcare systems in South Africa while combating information gaps and stigmas around HIV/AIDs that compromise trust within the medical community and communities confronting HIV/AIDs. Supervisory structures within the program act to ensure CHW support, program transparency, continuous conversations around problem solving, data reporting, and relationship management with the Department and/or Ministry of Health (DOH/MOH). Analysis of workflow and management structures within the clinic inform consultations with the DOH/MOH about wage structures and reporting lines to avoid distortions or conflicts.
The aim is to have by 2025 95% of people living with HIV/AIDs know their status, 95% of people with HIV/AIDs having enrolled on Anti Retro-Viral (ARV) treatment, and 95% of people on ARVs achieve viral suppression. As of 2023, these numbers 86%, 89%, and 93% respectively. Many countries face challenges with increasing diagnosis and treatment of the disease, however South Africa’s approach towards managing HIV/AIDs can become a template and model for other countries wanting to take action towards eradicating this deadly disease.
Additional Information
Mothers2mothers, Where We Work: South Africa.
