HIV/AIDS is a paradoxical disease. Unlike malaria or dengue, spread by unpredictable buzzing mosquitoes, or tuberculosis, spread by simply breathing the same air as an infected person, HIV requires intimate, intentional contact: sexual intercourse, sharing intravenous needles, or giving birth.
Yet, after conversations among friends living with HIV in America, Africa, and Asia over the past several years, it is clear to me that people rarely intend to spread the deadly human immuno-deficiency virus. Even in cases of rape and abuse, where violence is calculated, most cases of HIV are transmitted by people who do not realize they themselves are infected.
However, do not be fooled! There remains a different set of characters in the world today who spread HIV deliberately, and rather than targeting their peers, these individuals spread the virus to the youngest, most innocent generations, ensuring a domino-effect of devastation tumbling on long after their own demise.
“Who are these sick individuals?” one surely asks, dumbfounded and disturbed.
They are mothers.
Pregnant women, to be exact, moms-to-be who realize their HIV positive status – usually as a complete shock – only upon a prenatal examination. For many women in the developing world, this is the only doctor’s visit they make in their entire young adult life, and for women in conservative religious cultures, the first gynecological visit they are permitted to make, even if they have had sex before marriage.
These women are most often are married to men who have secretly (or openly) had sex with other women, or men who are injecting drug users. And these women will spread HIV to their children because they are faced with a limited set of dismal options: (1) give birth to my child with a 25% chance of transmitting HIV, because I cannot afford the prevention treatment, or (2) abort my child. And number two is rarely an option for women outside, and sometimes even within, Western nations.
HIV positive moms-to-be face far higher risk of infecting their little ‘partners’ than do intravenous drug users sharing needles (1:150), male sexual partners (1:10), or men having sex with women (1:200). And although mothers balance the burden of risk, the world owes our enormous global progress in responding to HIV/AIDS to these very women.
Though HIV/AIDS remains dismally documented, considering the modern deluge of data across finance and technology sectors, the regularity with which mothers seek prenatal care has provided the baseline data from which national estimates of HIV in a population are determined, in almost every nation in the world.
And so, in honor of Mother’s Day, I want to celebrate the powerful and selfless role that women, particularly mothers, have already played in fighting on the front-lines of the AIDS pandemic worldwide, by providing the data that helps shape interventions and attract funding for programs.
And at the same time, I want to highlight the even greater role mothers worldwide could be playing in heavily diminishing the transmission of HIV, as mothers in America and other Western countries have done over the past 10 years.
For all the lively and legitimate debate over quality of health care in America, it is noteworthy that the ailing system nevertheless manages to ensure nearly every HIV positive mother does not pass the virus to her child. The silver bullet? A simple, inexpensive program called Prevention of Mother to Child Transmission, or PMTCT.
Because the virus spreads from mother to child in three specific ways – crossing the placenta, during birth, and through breast milk – PMTCT interventions are targeted. Mothers are administered an antiretroviral drug, normally nevirapine, which alone lowers the risk of transmission from 25% to 8%, and combined with a cesarean section birth and formula to replace breast milk, HIV negative children are now regularly born to HIV positive mothers.
This ideal is however, far from reality in resource poor settings. Here in Indonesia, for example, the government subsidizes a full PMTCT program, but for a mere handful of women. For the many waitlisted, they are faced with the torturous toss of the dice: even if they can secure free antiretroviral drugs, as are offered in the capital cities of most nations worldwide, they are far too poor to pay a few dollars for formula everyday, never mind the $700 cesarean section.
Further, because HIV positive Indonesians are denied health insurance coverage, save for the one plan reserved for the poorest of the poor, many, including moms-to-be, will astoundingly (or perhaps logically) move to poorer neighborhoods, to smaller homes, to dirtier conditions, simply to qualify for coverage.
It is traumatic enough for a woman to realize at what should be a most joyous time of her life that her very life is now on a quicker countdown, and that the birthdays and graduations she dreamed of watching might now be too far out of reach.
To then deny this woman the chance to save her child’s life – considering that 50% of infants infected with HIV do not live to see their 2nd birthday – is not only unjust, it is archaic, and evidence that our health care and foreign aid systems are failing to properly allocate resources towards effective HIV prevention efforts.
In a world of psychologically complicated behavior change interventions – how to convince drug addicts to use clean needles, or promote universal condom use – HIV prevention interventions with pregnant women are one of the most sure-shot efforts our public health and foreign aid systems could and must be implementing in every nation affected by HIV/AIDS. And ideally, the progress of HIV-specific prenatal care will pave roads to ensure killers like malnutrition and diarrhea are stopped in their tracks as well. To make significant progress, PMTCT programs need funding and antiretroviral drug distribution systems need improvement, to ensure mothers in any city or village worldwide, have access to – at least – a lifesaving pill.
Mothers Day is not just an occasion to celebrate what mothers have done to help fight HIV/AIDS. Today we must seriously consider how HIV/AIDS efforts should be better helping mothers. So for all the dollars spent in Washington every year defending our right to bear arms, I hope to galvanize even a fraction of that energy today to invest in a woman’s right to bear a child. And when infected with HIV, the right – and frankly, the international regulation – that her baby is born without HIV.
If you are moved to act, please honor your mother today by donating to an organization like Keep a Child Alive (www.keepachildalive.org), whose targeted efforts at the Blue Roof Clinic in South Africa provide free PMTCT to hundreds of South African mothers. Additionally, advocate to your Senator to ensure U.S. foreign aid provides PMTCT within our President’s Emergency Plan for AIDS Relief (PEPFAR) programs.