The strongest scientific-journal rebuttal yet to the Obama Administration’s proposal to shift resources to maternal and child health at the expense of HIV/AIDS treatment scale up comes from two medical students, who in a commentary just published in AIDS make a clear and convincing case that such a move would actually undermine the health of women and children around the globe, not improve it.
“While we welcome the Mother and Child Campaign in a diverse portfolio of global health strategies funded by the United States, we are troubled by the ‘either/or’ mentality that places HIV/AIDS funding in direct opposition to initiatives to improve MCH,” write Sarah Leeper and Anand Reddi, who are studying medicine at Brown University and the University of Colorado respectively.
Referring to a JAMA article by Colleen Denny and Ezekiel Emmanuel that first outlined this proposal, they write: “We do not accept the premise by Denny and Emmanuel that the proportion of child deaths due to AIDS is ‘small,’ nor do we support the characterization of highly active antiretroviral therapy (HAART) as ‘new, complex, and expensive.’ We would argue that policies based on misrepresentations such as these threaten to undermine rather than support MCH worldwide.”
Leeper and Reddi take apart the Denny-Emmanuel argument piece by piece. For starters, they note that in the five countries with the highest HIV adult prevalence, HIV is the No. 1 cause of mortality for children under 5 years old. “One-thousand children were born with HIV everyday in 2007, due in part to the fact that <25% of all HIV-positive women worldwide have access to prevention of mother-to-child transmission,” they write.
The article also notes that all children born to HIV-positive mothers, whether they have HIV themselves or not, are at a much higher risk of death if maternal HIV is not treated. Leeper and Reddi point to a study of 3,468 children of HIV-positive mothers in Africa found that uninfected children with HIV positive mothers who gave birth “at an advanced disease stage” were at significantly higher risk of death. “This may be attributable in part to the fact that children with HIV-positive caregivers reside in food-insecure households more often than their unaffected peers, putting them at higher risk for malnutrition and death from diarrhea and acute respiratory infection,” they write.
Leeper and Reddi detail how HIV therapy is a cost-effective intervention and highlight the opportunities to build on PEPFAR and other global AIDS initiatives to improve maternal and child health, rather than doing the latter at the expense of the former. They note that clinical studies in Rwanda and Haiti have shown how PEPFAR has led to better maternal and child health outcomes.
“Confronting illness in isolation–whether by funding PEPFAR at the expense of programs that target MCH or vice versa–cannot be our way forward. Integrated health service delivery models that address the well-being of both HIV-positive and HIV-negative families, without prioritizing one at the expense of the other must be developed, funded, and implemented,” they conclude. “The complex and interrelated challenges of MCH against the devastating global backdrop of HIV require comprehensive models of care that combine HIV/AIDS and MCH initiatives.”
You can find their article here. It has been published online ahead of print.