Towards an HIV-free generation: getting to zero or getting to rights?

Chitembo, Amina; Dilmitis, Sophie; Edwards, Olive; Foote, C.E.; Griffiths, Leasuwanna; Moroz, Svetlana; Mungherera, Lydia; Mworeko, Lillian; Manchester, Jo; Margolese, Shari; Namiba, Angelina; Paxton, Susan J.; Ross, Gracia Violeta; Shahi, Sita; Welbourn, Susan Alice

doi:10.1016/s0968-8080(12)39638-9

Cited by 6 publications

(6 citation statements)

References 13 publications

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“…Throughout the rapid expansion of Option B+, there have been relatively few voices of caution or critique. Nonetheless, some have raised ethical concerns including the risk of impinging upon access for immuno-compromised men and non-pregnant women, the top-down nature of a policy developed with little-to-no input from communities, and the speed with which it was adopted and spread absent evidence of improved PMTCT outcomes [27][28][29][30].…”

Section: Introductionmentioning

confidence: 99%

Awareness and perceived fairness of option B+ in Malawi: a population‐level perspective

Yeatman

Trinitapoli

2017

Journal of the International AIDS Society

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Introduction: Policies for rationing antiretroviral therapy (ART) have been subject to on-going ethical debates. Introduced in Malawi in 2011, Option B+ prioritized HIV-positive pregnant women for lifelong ART regardless of the underlying state of their immune system, shifting the logic of allocation away from medical eligibility. Despite the rapid expansion of this policy, we know little about how it has been understood and interpreted by the people it affects. Methods: We assessed awareness and perceived fairness of the prioritization system for ART among a population-based sample of young women (n = 1440) and their partners (n = 574) in southern Malawi. We use a card-sort technique to elicit understandings of who gets ART under Option B+ and who should be prioritized, and we compare perceptions to actual ART policy using sequence analysis and optimal matching. We then use ordered logistic regression to identify the factors associated with policy awareness. Results: In 2015, only 30.7% of women and 21.1% of male partners understood how ART was being distributed. There was widespread confusion around whether otherwise healthy HIV-positive pregnant women could access ART under Option B + . Nonetheless, more young adults thought that the fairest policy should prioritize such women than believed the actual policy did. Women who were older, more educated or had recently engaged with the health system through antenatal care or ART had more accurate understandings of Option B + . Among men, policy awareness was lower, and was patterned only by education. Conclusions: Although most respondents were unaware that Option B+ afforded ART access to healthy-pregnant women, Malawians support the prioritization of pregnant women. Countries adopting Option B+ or other new ART policies such as universal test-and-treat should communicate the policies and their rationales to the public – such transparency would be more consistent with a fair and ethical process and could additionally serve to clarify confusion and enhance retention.

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Section: Introductionmentioning

confidence: 99%

Awareness and perceived fairness of option B+ in Malawi: a population‐level perspective

Yeatman

Trinitapoli

2017

Journal of the International AIDS Society

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“…From the perspective of women living with HIV, there has been far too much emphasis on women taking ARVs during pregnancy primarily to protect their sexual partners and babies from acquiring HIV, rather than for their own intrinsic health and wellbeing. Chitembo et al 72 in 2012 stated: ‘What is perhaps most disappointing... is the Global Plan’s narrow focus on disease prevention rather than on a holistic right to health for all concerned. Its overall focus is on perinatal HIV prevention, rather than on an affirmation of health, autonomy, life and rights for all, women and babies alike’.…”

Section: Ensuring Our Srhr and Our Priorities: The Perspective Of A Global Hiv Gender And Srhr Activistmentioning

confidence: 99%

Section: Ensuring Our Srhr and Our Priorities: The Perspective Of A G...mentioning

confidence: 99%

From presumptive exclusion towards fair inclusion: perspectives on the involvement of women living with HIV in clinical trials, including stakeholders’ views

Namiba

Kwardem

Dhairyawan

et al. 2022

Therapeutic Advances in Infection

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2journals.sagepub.com/home/tai black women were under-recruited by around 35%. They also found that despite most of the global burden of HIV being in low and low-middle-income countries, most of the trials were carried out in high and high-middle-income countries. A systematicreview 5 of HIV cure research published in 2015 found that women, as well as older people and those of non-white ethnicities were profoundly under-represented.This pattern of under-recruitment is not only seen in HIV, but in many disease areas including cardiovascular disease, 7 cancer, 8 and mental health conditions. 9 Sex and gender differences 10 in the prevalence,incidence, 11 symptomatology, andprogression 12 of a range of diseases have been described, as have differences in responses to treatment. These differences in treatment responses are likely to be attributable to differences in how the body deals with a drug (pharmacokinetics) and the effect of the drug on the body (pharmacodynamics). This may affect the efficacy and tolerability of thedrug. 13 Importantly, sex 14 and gender 15 inequalities 16 in social and economic power also have a large impact on health outcomes, affecting health-seeking behaviour, access to, and utilisation of healthcare services.journals.sagepub.com/home/tai 13Visit SAGE journals online journals.sagepub.com/ home/tai

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“…Women have long called for their rights to informed choice regarding if, when and how to take HIV medication, but this has been an ever-challenging issue, with women often being blamed and shamed if they do not adhere to medication ( Figure 5 ). 141 , 142 …”

Section: Accelerating Srhr: What Needs To Change?mentioning

confidence: 99%

What will it take to achieve the sexual and reproductive health and rights of women living with HIV?

Dunaway¹,

Brion²,

Hale³

et al. 2022

Womens Health (Lond Engl)

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This article outlines progress in realizing the sexual and reproductive health and rights of women and girls living with HIV over the last 30 years from the perspective of women living with HIV. It argues that the HIV response needs to go beyond the bio-medical aspects of HIV to achieve our sexual and reproductive health and rights, and considers relevant Joint United Nations Programme on HIV/AIDS (UNAIDS), World Health Organization, United States President’s Emergency Plan for AIDS Relief (PEPFAR), Global Fund and other guidelines, what engagement there has been with women living with HIV and whether guidelines/strategies have been adopted. It has been written by women living with HIV from around the world and a few key supporters. Co-authors have sought to collate and cite materials produced by women living with HIV from around the world, in the first known effort to date to do this, as a convergence of evidence to substantiate the points made in the article. However, as the article also argues, research led by women living with HIV is seldom funded and rarely accepted as evidence. Combined with a lack of meaningful involvement of women living with HIV in others’ research on us, this means that formally recognized evidence from women’s own perspectives is patchy at best. The article argues that this research gap, combined with the ongoing primacy of conventional research methods and topics that exclude those most affected by issues, and the lack of political will (and sometimes outright opposition) in relation to gender equality and human rights, adversely affect policies and programmes in relation to women’s rights. Thus, efforts to achieve an ethical, effective and sustainable response to the pandemic are hindered. The article concludes with a call to action to all key stakeholders.

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Towards an HIV-free generation: getting to zero or getting to rights?

Cited by 6 publications

References 13 publications

Awareness and perceived fairness of option B+ in Malawi: a population‐level perspective

Awareness and perceived fairness of option B+ in Malawi: a population‐level perspective

From presumptive exclusion towards fair inclusion: perspectives on the involvement of women living with HIV in clinical trials, including stakeholders’ views

What will it take to achieve the sexual and reproductive health and rights of women living with HIV?

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