Prevention of mother-to-child transmission of HIV among Female Sex Workers in Africa — It should be a priority.
Early in the HIV pandemic, vertical HIV transmission ( mother-to-child transmission of HIV) was a major driver of new HIV infections. For instance, in the absence of any intervention, the risk of HIV transmission from a mother living with HIV to her child ranges from 15–45%. Transmission may occur during pregnancy, labor, delivery and postnatally through breastfeeding. With antiretroviral treatment (ART) for the mother and prophylactic treatment for the child, this risk can be reduced to effectively 0. In 2011, a global plan towards the elimination of new HIV infections among children was launched with a target of significantly reducing new HIV infections among children and maternal deaths attributable to HIV by 2015. The plan galvanized global efforts and currently, several countries including Cuba, Armenia, Belarus and Thailand among others have eliminated vertical transmission.
In countries across sub-Saharan Africa, there has also been tremendous progress especially in Eastern and Southern Africa, the regions with the greatest burden of HIV globally. Since 2010, there has been a 56% decrease in new HIV infections among children born to mothers living with HIV. However, no country in the region has eliminated vertical transmission yet, and half of all annual vertical transmission infections globally occur in countries across the region. Moreover, it is unclear of who and why people are still at risk for vertical transmissions and whether all people are at equal risk. In this context, there is a limited understanding of the risks among some key populations including female sex workers (FSWs). Yet, FSWs are a group with a very high burden of HIV globally and in countries across Africa; and most of them are mothers. Unfortunately, the stigma, discrimination and criminalization that affect sex workers prevent their access to HIV prevention and treatment services. In response, we recently conducted a study among FSWs in Port Elizabeth, South Africa to better understand mother-to-child HIV transmission (MTCT) risks among them.
In this study, more than half of women who participated were living with HIV, the majority had been pregnant in the past and a significant proportion among those who had been pregnant reported history of unintended pregnancy. Among FSWs who were HIV negative and not intending to conceive, there were low levels of consistent condom use and of long-term contraceptive use. Of the women who were living with HIV and had children less than 5 years old, more than one in ten reported having a child who was HIV positive. In contrast, the overall MTCT rate among women in South Africa is around 1 in fifty. Additionally, about a third of new mothers living with HIV had been infected after their last delivery showing substantial HIV acquisition risk. Finally, less than half of participants who were living with HIV reported ART use during pregnancy. ART use was also low among all FSWs who were living with HIV at the time of the study. In contrast, more than nine out of every ten women living with HIV in South Africa have access to ART during pregnancy .
Overall, we found that FSWs in Port Elizabeth, South Africa had a high HIV burden and were not adequately reached by interventions focused on preventing vertical transmission despite a strong national program in South Africa. Moving forward means starting to address the underlying structural determinants like laws and policies that prevent effective engagement for sex workers across South Africa and beyond in the region. We talk a lot about ending AIDS…but how can we end AIDS if there remains children born with HIV today. We have to do better.
The full article has been published in BMC public health under the title: Evaluating the vertical HIV transmission risks among South African female sex workers; have we forgotten PMTCT in their HIV programming? and may be found on this link: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-6811-4
