Any views expressed in this article are those of the author and not of Thomson Reuters Foundation.
Sarah West is media manager at International HIV/AIDS Alliance. The opinions expressed are her own.
Giving birth should be about giving life. Not death,” says Lucia, an activist from Zambia.
Every day in Uganda 16 women die giving birth and each year more than 30,000 babies are born with HIV.
In Kenya maternal mortality has become so commonplace that in some areas pregnant women are referred to as ‘living corpses’.
Cisarena Yeli, aged 38 from South Sudan, has seven children. She nearly died giving birth because she couldn’t get to a health clinic to deliver her baby.
HIV alone accounts for 61,000 maternal deaths every year, with HIV positive mothers four to eight times more likely to die during childbirth than HIV negative women.
Despite the medical advances that are available to test women for HIV and prevent mothers from passing HIV to their unborn child, every day 1000 children are born HIV positive. The figures are mind boggling.
This World AIDS Day the International HIV/AIDS Alliance is focusing attention on the impact HIV has on women and girls.
The stigma and discrimination faced by women living with HIV make it extremely difficult for them to access health services which in turn increases the risk of their children being born with HIV.
Women often fear being tested for HIV in the first place, worried they’ll be accused of bringing HIV into the community or their home and face physical violence or banishment from their partners.
In poorer countries the health infrastructure is severely limited. Often, a handful of staff have to meet the needs of thousands and distances are simply too great for a woman to travel to get to a health centre.
In some cultures women need the permission of their male partners to seek medical care and if there are fees to pay many people simply cannot afford them.
Yes, the challenges are huge but there are signs of progress. For the first time we have within our grasp the strong possibility of eliminating new HIV infections in children.
We have the scientific know-how to test and treat HIV. More people are able to access treatment. There is strong evidence of community involvement in delivering effective maternal and child healthcare and tackling the HIV epidemic.
Over the last year the Alliance has been working on a project in South Sudan, Kenya, Zambia and Uganda to increase the demand for healthcare services by pregnant women and their partners.
It has also developed effective national level advocacy to build better policy environments that link HIV prevention with maternal, newborn child health and promote the integration of sexual and reproductive health services.
More than 100,000 people were reached in just six months of the project. In all four countries, the programme improved people’s understanding of the links between maternal and child health, HIV and sexual and reproductive health.
More than 80,000 women were referred to health care facilities offering antenatal care, prevention of mother to child transmission (PMTCT) services and delivery.
Much of this success is down to the work of community based organisations. One such organisation is Action for Rights Relief and Development (ARRD), based in Pageri Payam district in Eastern Equatoria in South Sudan.
ARRD, which covers an area of around 23,000 people, arranged for peer educators to give talks at villages about health in pregnancy, delivery and maternity and HIV, and encouraged women to go to health services for PMTCT.
To overcome the distances women in Pageri Payam have to travel to get to health centres ARRD provided transport in the form of a Raksha (ambulance).
The organisation then followed up health centre visits, coordinating with traditional birth attendants to make sure the advice given is actually being followed.
Margaret Oleyo is 30-years-old. She has six children and her baby Juma, is 3-weeks-old. She told us: “I always have complications giving birth. I have received peer education from ARRD and I know how important it is to be properly attended to for me and my baby... Thanks to ARRD I could deliver in Juma in hospital. Before, I had to pay for and find transportation to go to hospital. I don’t think I could have afforded it this time. Many families don’t even think about delivering in the clinic, even if it is close, because the clinic makes them pay for the maternity kit.”
Community workers also make a difference for health staff.
In Luwero district, Uganda, local community Network Support Agents (NSAs), people living with HIV that are trained to support people in their community on HIV and maternal health issues, encourage and support women to attend local health centres.
Juliet Aheebwa from Bombo health centre said that the NSAs make their lives easier: “The patients feel good when they see NSAs while they are at the clinic. They feel free to air their concerns. Our workload reduces because they give health education talks and work with people to help them take their medication. The number of women we deliver now has increased from 10 to 35 in a day. There are certain things that clients don’t tell us but will share with the NSAs so they give us feedback and that helps us.”
The success of this project shows just what communities can achieve and the difference we can make to women’s lives but projects like this are in jeopardy.
Funding for HIV/AIDS is dramatically declining.
Donor funding decreased by 10 percent in 2010 and the critical donor contributions from the Global Fund to fight AIDS, TB and Malaria are 20 percent less than was pledged, which has led to the Fund cancelling its next funding round, the first time this has happened since it was established ten years ago.
The implications are serious as thousands of women continue to die while giving life and babies are being born HIV positive we stand at a tipping point where all our progress on PMTCT, treatment and improving access to healthcare may be lost.
We have a choice. Let’s make it one we can all live with.