Gender and racial inequalities in Latin America continue to hamper efforts to prevent HIV infections in children, where nearly 7,000 are newly infected each year.
Gender and racial inequalities in Latin America continue to hamper efforts to prevent HIV infections in children, where nearly 7,000 are newly infected each year.
During a special session on HIV and children at the HIV Drug Therapy 2014 Americas Conference in Rio de Janeiro last month, delegates set the goal to increase antenatal coverage to more than 95 per cent of all pregnant women.
Key HIV targets for 2015 include reducing mother to child transmission to less than two per cent and achieving a rate of less than 0.3 per cent new infections per 1,000 babies born. Another target is to achieve a rate of less than 0.5 per cent of cases of congenital syphilis per 1,000 newborns.
Challenges for Latin America
But there is still a long way to go. According to the UNAIDS Report on the Global AIDS Epidemic 2012, the estimated rate of mother to child transmission in Latin America and the Caribbean is 14 per cent.
A comprehensive approach to virtual elimination of HIV in children must include HIV counselling and testing, antiretroviral treatment for all pregnant women before and after delivery (let’s keep mothers alive!) and early diagnosis and treatment for infants. This is still far from ideal in the region.
Latin America still has major inequities, especially among women, indigenous population and migrants, who face barriers in accessing healthcare. For instance, in Buenos Aires, Argentina, thousands of migrants from rural areas in Bolivia have different cultural standards, habits and language.
Recovering childhood
Fortunately there are innovative and creative solutions. Dr Teresa Rodriguez has been working as a pediatrician in infectious diseases for twenty years in a public hospital in Buenos Aires, surrounded by slums which are home to a huge number of Bolivian migrants. Dr Rodriguez found that people would not come to the office until they were very sick and died. “I discovered white is the colour which is used for funerals and is associated with death. Not wearing a white gown was a good start,” she says.
Dr Rodriguez also treats many children living with HIV in difficult social situations, such as domestic violence or having parents in prison or who use drugs.
She says: “One of my patients, a 16 year old boy, is a cartonero, which means he makes his living by picking up garbage and recycling paper. He is living with HIV and has a terrible personal history of losses, poverty and violence.
“Every year with my colleagues at the hospital we hold a Christmas party and invite our children living with HIV, their families, friends and teachers. At the party, my 16 year old patient won a plush bear. His eyes turned wet and his face lit up with the most beautiful smile ever seen. Like many children in similar situations, he needed to recover his childhood.”
Reducing risk to newborns
Pregnancies among young people who were born with HIV is another growing challenge. Twenty years ago, the administration of zidovudine during pregnancy, labour and to the newborn for six weeks was found to reduce perinatal transmission by nearly 70 per cent.
Now, in high income countries, mother to child transmission has been virtually eliminated through universal testing and counselling, access to effective antiretrovirals, safer delivery, family planning and safe use of breast milk substitutes. These interventions have reduced the risk to less than five per cent, even in breastfeeding mothers.
But in many parts of Latin America, adolescent girls who were born with HIV were simply not there for these successes. And now they are becoming pregnant themselves and risk passing on HIV to their own children.
Adolescent pregnancies
At the Rio conference, Dr Marinella della Negra, from Sao Paulo, Brazil, shared her experience with 127 perinatally HIV positive girls aged 14 and older, of whom 30 became pregnant, some of them twice or three times. Less than 50 per cent had controlled their virus, which means they are not receiving effective treatment (even though it is universally available in Brazil).
While 26 of the adolescent mothers had a fixed sexual partner, not all had told them of their HIV status. Not all pregnancies were planned or desired, which is another challenge for healthcare services. Not only should these be adolescent-friendly, but they should also take safe contraception into consideration.
A desired and planned pregnancy can be safe, both for the adolescent mother and the baby. However if the mother is not not using condoms regularly, or has a detectable viral load (which means the virus is not under control despite treatment) then hormonal monthly injections is a safer choice.
Cauldron of machismo
For many women and girls, time seems to have stood still in Latin America. Stigma and gender inequities are a direct consequence of traditional views about the place and role women should occupy in society – and the obstacles young girls face reveal just how unequal things remain.
For example, 69 per cent of the 7,551 recently reported cases of domestic or sexual violence in Peru involved girls under the age of 17 and, in Bolivia, 70 per cent of girls do not go to school.
Latin America and the Caribbean is still a cauldron of machismo and, within this context, universal HIV prevention and treatment looks hard to achieve. Unfortunately there is still a long walk to equity.
Read more stories about HIV and human rights
Image: Advocacy worker with her son, Ecuador
© 2006 Marcela Nievas for International HIV/AIDS Alliance
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