Scaling Up HIV/AIDS Care Among Women in Sub-Saharan Africa: Cross-Cultural Barriers
The HIV/AIDS epidemic wears a predominantly female face as evidenced by the exceptionally high women’s vulnerability to HIV infection particularly in the sub-Saharan Africa (SSA) region. Women and girls continue to be affected disproportionately by HIV infection relative to men and boys, and they account for approximately 60 % of the estimated HIV infections worldwide. Women in the developing world confront serious socio-cultural, economic, and gender disadvantages that influence the dynamics of HIV/AIDS among females. It is critical, therefore, to have strategies to expand culturally appropriate and acceptable prevention and care for women especially in the developing world.
In this chapter, we review the cross-cultural perspectives, norms, and practises around motherhood that present unique challenges to the scale-up of HIV prevention, care, and treatment interventions in SSA. We consider socio-cultural issues surrounding pregnancy and childbirth, family planning and infertility, disclosure of HIV serostatus and HIV sero-discordance, conflict and war, and how these have affected the uptake and scale-up of HIV/AIDS prevention, treatment, and care programs. We tackle specific vulnerable groups of girls/women such as adolescents and orphans and how these groups have increased vulnerability to HIV infection in the African sociocultural context .We also highlight some strategies to make the current prevention, care, and treatment interventions adaptable to the specific socio-cultural boundaries encountered by the cross-cultural HIV/AIDS epidemic.
Women’s access, uptake, and adherence to comprehensive HIV/AIDS prevention and treatment/care programs including prevention of mother-to-child transmission of HIV (PMTCT) and highly active antiretroviral therapy (HAART) are hampered by numerous socio-cultural constraints including socio-economic status, power and gender inequalities, male dominance of women’s decision-making processes, and continuous strive of women to conform to society expectations as well as the prestige surrounding motherhood. In order to reach all the women in need of HIV/AIDS care and change the tide of the HIV/AIDS epidemic, the prevention care and treatment interventions should be tailored to address the socio-cultural perspectives, norms, and practises of the communities affected by the epidemic. We recommend a large base of operational research in the different sociocultural settings in order to develop evidence-based local solutions for site-specific problems.
KeywordsPMTCT Service Unborn Baby MTCT Rate Sociocultural Setting Prevention With Positive
The authors acknowledge the Sewankambo scholarship program at the Infectious Diseases Institute, Makerere College of Health Sciences, that has made it possible for Damalie Nakanjako to undertake this review.
- Arnfred S (2003) Images of ‘motherhood’ – African and Nordic perspectives. J Cult Afr Women Stud 4:80. Online journal: http://www.africaknowledgeproject.org/index.php/jenda/article/view/80
- Beyeza-Kashesya J, Ekstrom AM, Kaharuza F, Mirembe F, Neema S, Kulane A (2010) My partner wants a child: a cross-sectional study of the determinants of the desire for children among mutually disclosed sero-discordant couples receiving care in Uganda. BMC Public Health 10:247PubMedCrossRefGoogle Scholar
- Breastfeeding in public around the world (2009) http://www.007b.com/public-breastfeeding-world.php. Accessed 22 Aug 2011
- Denomme S (2009) Let’s talk about the cultures of childbearing. http://pregnancy.families.com/blog/lets-talk-about-the-cultures-of-childbearing. Accessed 15 Dec 2009
- Echezona-Johnson C (2009) Rituals for honoring pregnancy in different cultures. http://www.helium.com/items/852948/-rituals-for-honoring-pregnancy-in-different-cultures. Accessed 15 Dec 2009
- Helman CG (1994) Culture, health and illness: an introduction to health professionals. http://www.amazon.com/Culture-Health-Illness-Cecil-Helman/dp/0723608415. Accessed 22 Aug 2011
- Kimani M (2008) Investing in the health of Africa’s mothers. Afr Renew 4:8Google Scholar
- Mama A (2002) Gains and challenges; linking theory and practice. www.gwsafrica.org/knowledge/mama. Accessed 21 Aug 2011
- Mother2mother (2007) AIDS counselling from mother to mother. http://www.sagoodnews.co.za/health_and_hiv_aids/aids_counselling_from_mother_to_mother.html. Accessed 22 Aug 2011
- Nguyen TA, Oosterhoff P, Ngoc YP, Wright P, Hardon A (2008) Barriers to access prevention of mother-to-child transmission for HIV positive women in a well-resourced setting in Vietnam. AIDS Res Ther 5(7). http://www.aidsrestherapy.com/content/pdf/1742-6405-5-7.pdf. Accessed 12 Oct 2011
- Ostergard R, Tubin M (2008) Rape and the HIV/AIDS epidemic: evidence from South Africa. Paper presented at the ISA’s 49th annual convention, bridging multiple divides, San Francisco, CA, USAGoogle Scholar
- Oyewumi O (2003) Abiyamo: theorizing African motherhood. J Cult Afr Women Stud 4:79. Online journal: http://www.africaknowledgeproject.org/index.php/jenda/article/view/79
- Population Council (2011) The prevention and management of HIV and sexual and gender-based violence: responding to the needs of survivors and those-at-risk. http://www.popcouncil.org/pdfs/2011_HIVSGBVBrief.pdf. Accessed 22 Aug 2011
- Radcliffe R (2009) Rituals for honoring pregnancy in different cultures. http://www.helium.com/items/852948/-rituals-for-honoring-pregnancy-in-different-cultures. Accessed 15 Dec 2009
- UNAIDS (2008) Report on the global AIDS epidemic. http://www.unaids.org/en/dataanalysis/epidemiology/2008reportontheglobalaidsepidemic/. Accessed 14 Mar 2011
- UNAIDS (2009) AIDS Epidemic update. http://www.unaids.org/en/dataanalysis/epidemiology/2009aidsepidemicupdate/. Accessed 14 Mar 2011
- UNICEF (2009) Children and AIDS: third stocktaking report advocates early HIV testing. http://www.unicef.org/eapro/media_9720.html. Accessed 14 Mar 2011
- United Nations (2010) The UN total fertility ranking 2005–2010. List of countries and territories by fertility rate. http://en.wikipedia.org/wiki/Total_fertility_rate. Accessed 22 Aug 2011
- World Health Organization (2009) Rapid advise: use of antiretroviral therapy drugs for treating pregnant women and preventing HIV infection in infants. www.who.int/hiv/pub/mtct/rapid_advice_mtct.pdf. Accessed 14 Mar 2011