A Lifecycle Approach to HIV Prevention in African Women and Children

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.

Confronting Cultural Silencing of Women: Untold Stories of Abuse and HIV Risk in Young Women in Africa and the United States

“…The goal of this study was to gain a deeper understanding of the experiences of African women who are increasingly at risk for HIV infection and living with or vulnerable to sexual abuse. While the expansion of antiretroviral therapy in sub‐Saharan Africa has contributed to reductions in the incidence of HIV/AIDS in Africa (Delva & Abdool Karim, ), more work is needed to improve our understanding of factors influencing higher HIV rates in younger African women (Roxby et al, ). Several studies have associated HIV risk in African women with stigma, silence, and shame, especially among those who also experience sexual abuse (Byrskog, Olsson, Essén, & Allvin, ; Loutfy et al, ; Sprague, Hatcher, Woollett, Sommers, & Black, ).…”

“…In the context of an HIV/AIDS epidemic, we need to gain a better understanding of cultural practices influencing African girls and their experience of abuse. We must advance an integrated approach to preventing sexual abuse to scale back the HIV pandemic and realize meaningful health outcomes (Roxby et al, ).…”

The impact of programs for prevention of mother-to-child transmission of HIV on health care services and systems in sub-Saharan Africa - A review

“…Rollins N et al 2007/ RSA [ 87 ] Quantitative Immunisation Surveillance of MTCT prevention programs at immunisation clinics Anonymous HIV prevalence screening of all infants at immunisation clinics is feasible and could help to monitor the impact of PMTCT programs in peripartum infection, in identifying the infected children early for referral into care and treatment 39. Roxby AC et al 2014/ Multicountry [ 66 ] Review MCH A lifecycle approach to HIV prevention in African women and children The potential for synergistic and additive benefits of lifecycle interventions should be considered when scaling up HIV prevention efforts in SSA 40. Ruton H. et al 2012/ Rwanda [ 67 ] Mixed Child health, community PMTCT - community-based household survey National PMTCT programs in SSA should assess the effectiveness of their interventions to achieve the MTCT elimination goals 41.…”

Implementation Research for the Prevention of Mother-to-Child HIV Transmission in Sub-Saharan Africa: Existing Evidence, Current Gaps, and New Opportunities

“…There now exists a growing body of evidence that biomedical and behavioral interventions used in combination can dramatically reduce incident HIV infection at a population level. A number of review articles have been published over the past several years, which together provide a comprehensive survey of the field [13–15]. Here, we emphasize three areas of particular relevance to women of childbearing age.…”