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A Lifecycle Approach to HIV Prevention in African Women and Children

  • The Global Epidemic (S Vermund, Section Editor)
  • Published:
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Abstract

Effective biomedical and structural HIV prevention approaches are being implemented throughout sub-Saharan Africa. A “lifecycle approach” to HIV prevention recognizes the interconnectedness of the health of women, children and adolescents, and prioritizes interventions that have benefits across these populations. We review new biomedical prevention strategies for women, adolescents and children, structural prevention approaches, and new modalities for eliminating infant HIV infection, and discuss the implications of a lifecycle approach for the success of these methods. Some examples of the lifecycle approach include evaluating education and HIV prevention strategies among adolescent girls not only for their role in reducing risk of HIV infection and early pregnancy, but also to promote healthy adolescents who will have healthier future children. Similarly, early childhood interventions such as exclusive breastfeeding not only prevent HIV, but also contribute to better child and adolescent health outcomes. The most ambitious biomedical infant HIV prevention effort, Option B+, also represents a lifecycle approach by leveraging the prevention benefits of optimal HIV treatment for mothers; maternal survival benefits from Option B+ may have ultimately more health impact on children than the prevention of infant HIV in isolation. The potential for synergistic and additive benefits of lifecycle interventions should be considered when scaling up HIV prevention efforts in sub-Saharan Africa.

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Acknowledgements

This paper benefitted greatly from discussions held as part of the multidisciplinary University of Washington Center for the Integrated Health of Women, Adolescents and Children (Global WACh), a joint effort led by the Departments of Global Health, Pediatrics, and Obstetrics and Gynecology.

Funding

ACR: is supported by K23 HD071788-01A1 from the National Institute of Child Health and Development (NICHD), and by a New Investigator Award from the University of Washington (UW) Center for AIDS Research (CFAR), an NIH funded program (P30 AI027757), which is supported by the following NIH Institutes and Centers (NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NIA). JAU: is supported by K12 HD09026 (NICHD) and by UW CFAR. JAS: is supported by K01 AI087369 from the National Institute of Allergy and Infectious Diseases (NIAID), the Royalty Research Fund, and a New Investigator Award from the UW CFAR. JK: is supported by P01 AI082976-01 and R01-HD075108 (NIAID), and 1R24TW008907 (NIH). GJS: is supported by K24 HD054314 and R01 HD023412-21 (NICHD), and P01 AI082976-01 (NIAID). JLW: is supported by U19 AI 090882 (NIAID) and by awards from the Bill & Melinda Gates Foundation.

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Conflict of Interest

Alison C. Roxby, Jennifer A. Unger, Jennifer A. Slyker, John Kinuthia, Andrew Lewis, Grace John-Stewart, and Judd L. Walson declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Medicine, University of Washington, 325 9th Avenue, Box 359909, Seattle, WA, 98104, USA

    Alison C. Roxby, Grace John-Stewart & Judd L. Walson

  2. Department of Obstetrics and Gynecology, University of Washington, 325 9th Ave, Box 356460, Seattle, WA, 98104, USA

    Jennifer A. Unger

  3. Department of Global Health, University of Washington, 325 9th Ave, Box 359909, Seattle, WA, 98104, USA

    Jennifer A. Slyker, Andrew Lewis, Grace John-Stewart & Judd L. Walson

  4. Department of Reproductive Health, Kenyatta National Hospital, Ngong Road, Box 2590-00202, Nairobi, Kenya

    John Kinuthia

  5. Department of Research & Programs, Kenyatta National Hospital, Ngong Road, Box 2590-00202, Nairobi, Kenya

    John Kinuthia

  6. Department of Pediatrics, University of Washington, 325 9th Ave, Box 359909, Seattle, WA, 98104, USA

    Grace John-Stewart & Judd L. Walson

  7. Department of Epidemiology, University of Washington, 325 9th Ave, Box 359909, Seattle, WA, 98104, USA

    Grace John-Stewart & Judd L. Walson

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  1. Alison C. Roxby
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Roxby, A.C., Unger, J.A., Slyker, J.A. et al. A Lifecycle Approach to HIV Prevention in African Women and Children. Curr HIV/AIDS Rep 11, 119–127 (2014). https://doi.org/10.1007/s11904-014-0203-2

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