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PEPFAR Goes Beyond HIV

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Joe DeCapua
U.S. efforts to help those infected with HIV in sub-Saharan Africa have saved millions of lives. But they’ve had another benefit as well – better care for pregnant women who are not HIV positive.



There’s been a great deal of concern and debate over the years about whether spending a lot of money to fight HIV/AIDS would divert attention from other health problems. So much so, that the Office of the U.S. Global AIDS Coordinator and the Centers for Disease Control wanted a definite answer. They asked Columbia University’s Mailman School of Public Health to find out.

The lead author of the study, Dr. Margaret Kruk, an assistant professor of Public Health and Management, said they collected data from 257 health facilities in eight African countries.

“We don’t have a negative story here that HIV programs have elbowed out HIV-negative women from delivering or for coming for ante-natal care. We don’t have that, which I think is one big take away,” she said.

In fact, it may be just the opposite. PEPFAR, the President’s Emergency Plan for AIDS Relief, has not only expanded treatment programs, but has also led to more modern health facilities.

Kruk said, “For example, having a larger HIV program, instead of dissuading women or women being worried about stigma or other things, actually those larger programs tended to have more deliveries by HIV-negative women over time. Our hypothesis here is that women, no matter how poor or whether they’re literate or illiterate, are very concerned about quality of care when it comes to delivery. And many times just the fact that they deliver with a midwife or traditional midwife doesn’t mean they don’t care about quality of care, but often it’s all they can afford. Or perhaps they can’t get to a good enough facility.”

And without quality health care, pregnancy complications can kill. Kruk said 10 to 15 percent of women in sub-Saharan Africa face such complications as obstructed labor and other life-threatening problems.

“High blood pressure, which can come up out of the blue. You could have been healthy your whole pregnancy and then develop that in labor, which can cause seizures. It can kill the mother and the baby. Another very, very common issue in sub-Saharan Africa is post-partum hemorrhage, where after the delivery the woman continues to bleed and can in fact bleed out her whole blood supply. That’s the main killer actually of mothers in sub-Saharan Africa,” she said.

Women may already be anemic before delivery as of result of malaria. So, when they see or hear about a health care facility with modern drugs and equipment they want to take advantage of that.

She said, “Women in rural Africa are not so different from women in New York City and women in Minnesota and women in Florida. You know, all of these women want to survive their delivery. They want the best possible care. It’s just that the big difference is women in Africa don’t have access to the quality of care that they want. And many times when they don’t see that access they would rather stay at home.”

Half of the world’s maternal deaths occur in sub-Saharan Africa. Lowering maternal and newborn mortality rates may be one of the benefits of PEPFAR.

Dr. Kruk said the findings indicate PEPFAR is a success story, adding there’s a major lesson to be learned when providing health care.

“It comes back to quality, quality, quality.”

Kruk added that policymakers face the challenge of “how best to implement HIV services while supporting other essential healthcare.”

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