How evidence based are public health policies for prevention of mother to child transmission of HIV?BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3763 (Published 20 June 2013) Cite this as: BMJ 2013;346:f3763
All rapid responses
Re: How evidence based are public health policies for prevention of mother to child transmission of HIV?
The editorial on vertical transmission of HIV, questioning new WHO policy for mass lifelong treatment of women living with HIV was refreshingly patient- and woman-centred (1). Women with HIV often experience gender-based violence as a cause or consequence of HIV (2,3,4). Even going to the hospital to access ARVs can cause some women to experience intimate partner violence (5). As the lived experiences of women with HIV touch so many 'difficult' and stigmatised areas (including intimate partner violence, rape, sex work, injection drug use, imprisonment, trafficking and war), maybe it would be better to involve them right from the start; to treat them as individuals with agency and rights (6). Women should not be treated as a means to an end rather than ends in themselves. The use of "best guesses" rather than evidence (1) and 'blaming' language (7,8) can only exacerbate women’s vulnerability to intimate partner violence, unless extremely carefully managed. Thus the new WHO guidelines regarding HIV treatment for women and for children are bound to meet community resistance from those with lived experience of these matters - as well as from those doctors (1,9) who echo our concerns (10).
1. Van de Perre P, Tylleskär T, Delfraissy J-F, Nagot N, How evidence based are public health policies for prevention of mother to child transmission of HIV? BMJ 2013;346:f3763
2. WHO Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence 2013
3. Hutchinson J, Perry G, Violence as a cause of consequence of HIV for women in England Sophia Forum 2013
4. Hale, F. & Vazquez, MJ. Violence against women living with HIV/AIDS: A background paper. 2011 Development Connections and the International Community of Women living with HIV/AIDS (ICW Global), with the support of UN Women
5. Salamander Trust, COWLHA and Chadwick D Seeking Safety: Stepping Stones in Malawi 2013 https://vimeo.com/69251113
6. Petretti S and Welbourn A HIV, health and human rights – for us all. HIV Nursing 2012, 17-21
7. Dilmitis S et al. Journal of the International AIDS Society 2012, 15(Suppl 2):17990
8. Welbourn A, The Pillars and Possibilities of a Global Plan to Address HIV in Women and Their Children RHRealityCheck 2013 9 June
9. Coutsoudis A, Goga A, Desmond C, Barron P, Black V, Coovadia H. Is Option B+ the best choice? Lancet 2013;381:269-71.
10. Chitembo A et al Towards an HIV-free generation: Getting to Zero or Getting to Rights? RHM Journal 2012;20;39Supp;5-13.
Emma Bell, Sophia Forum Trustee
Professor Susan Bewley FRCOG, Sophia Forum Trustee
Louise Binder, LL.B LL.D(Hon) O.Ont International Community of Women living with HIV/AIDS Global
Rachael Ekiring, Sophia Forum Trustee
Carrie Foote PhD, Indiana University and the Women’s Research Initiative on HIV/AIDS
Mariana Iacono Argentina network of women living with HIV/AIDS
Rebecca Matheson ICW Global Steering Committee
L’Orangelis Thomas Negrón, Puerto Rico
Susan Paxton PhD, Women of Asia Pacific Plus
Silvia Petretti, Deputy CEO, Positively UK
Sindi Putri, Indonesia
Violeta Ross, Bolivian Network of People Living with HIV and AIDS
Jacqueline Stevenson, Sophia Forum Trustee
Martha Tholanah, Zimbabwe
Alice Welbourn PhD, Founding Director, Salamander Trust
Jessica Whitbread, ICW Global Chair
Competing interests: No competing interests