Interactive Workshop by the Commonwealth Pharmacists Association HIV/AIDS, Maternal Health, Child Health and TBChennai, India11 – 12 March 2010

Interactive Workshop by the Commonwealth Pharmacists Association HIV/AIDS, Maternal Health, Child Health and TBChennai, India11 – 12 March 2010

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Global estimates for adults and children, 2008

• People living with HIV 33.4 million [31.1 – 35.8 million]

• New HIV infections in 2008 2.7 million [ 2.4 – 3.0 million]

• Deaths due to AIDS in 2008 2.0 million [1.7 – 2.4 million]

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HIV/AIDS in the Commonwealth

• Population: 1.8 billion - 28% of the world’s total.

• Two thirds (2/3) of all people living with HIV/AIDS.

• 25 million of the 33.4 million people living with HIV/AIDS worldwide.

• 4 million of the 6 million people in need of ARV

• Three the countries with increasing number of infected and affected people are South Africa, Nigeria and India, all in the Commonwealth.

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The most heavily affected.

Accounted for 72% of the world’s AIDS-related deaths in 2008.

Impact on life expectancy in heavily affected countries

Huge impact on women.

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In 2008, 4.7 million people in Asia were living with HIV.

Regionally, the epidemic has remained somewhat stable since 2000.

India accounts for roughly half of Asia’s HIV prevalence.

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There is geographic variation between and within countries and regions.

The epidemic is evolving. There is evidence of successes in

HIV prevention Improved access to treatment is

having an impact.There is increased evidence of risk

among key populations. 04/21/23 6

The need to understand individual epidemics and national responses.

Focussing on the vulnerabilities particularly Persons Living With HIV and AIDS.

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Why is the epidemic still spreading?

The major cause is the slow uptake and progress of HIV/AIDS prevention, treatment and care services.

HIV/AIDS stigma and discrimination is a direct cause.

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Maternal Health

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180–200 million pregnancies per year

75 million unwanted pregnancies

50 million induced abortions

20 million unsafe abortions (same as above)

600,000 maternal deaths (1 per minute)

1 maternal death = 30 maternal morbidities04/21/23

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3 million neonatal deaths (first week of life)

3 million stillbirths

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Every Minute... 380 women become pregnant

190 women face unplanned or unwanted pregnancy

110 women experience a pregnancy related complication

40 women have an unsafe abortion

1 woman dies from a pregnancy-related complication

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24.8

14.9

12.96.912.9

7.9

19.8

Hemorrhage 24.8%

Infection 14.9%

Eclampsia 12.9%

Obstructed Labor6.9%Unsafe Abortion12.9%Other Direct Causes7.9%Indirect Causes19.8%

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Delay in decision to seek care Lack of understanding of complications Acceptance of maternal death Low status of women Socio-cultural barriers to seeking care

Delay in reaching care Mountains, islands, rivers — poor organization

Delay in receiving care Supplies, personnel Poorly trained personnel with punitive attitude Finances

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Good quality maternal health services are not universally available and accessible > 35% receive no antenatal care ~ 50% of deliveries unattended by

skilled provider ~ 70% receive no postpartum care

during 1st 6 weeks following delivery

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Historical Review Traditional birth attendants Antenatal care Risk screening

Current Approach Emergency Obstetrics Care Skilled attendant at delivery Active Management of 3rd stage of labour.

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Introduction of system of health facilities

Expansion of midwifery skills

Decreased use of home delivery and delivery by untrained birth attendants

Spread of family planning04/21/23

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R2 = 0.74

0

200

400

600

800

1000

1200

1400

1600

1800

2000

0 10 20 30 40 50 60 70 80 90 100

Y Log. (Y)

The higher the proportion of deliveries attended by skilled attendant in a country, the lower the country’s maternal mortality ratio

% skilled attendant at delivery

Mat

erna

l dea

ths

per

1000

000

live

birt

hs

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Countdown to 2015 is a collaborative effort to track progress in Maternal, Newborn and Child Survival in HIGH mortality countries involving a range of instituions and individuals.

It highlights the progress, obstacles and solutions to achieve MDG4 (Child Survival) and MDG5 (Maternal and Newborn).

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Source: Lancet Countdown Coverage writing group, Lancet Countdown special issue, 2008

The countdown prioritizes 68 countries which together account for 97% of Maternal, Newborn and Child deaths worldwide each year.

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VI. Three steps to save lives of Women and their Newborn

Three (3) Progress Strategy:

1. All women must have access to reproductive health care including contraception to enable them to control the number and spacing of their children.

2. All pregnant women must have access to skilled care at the time of birth, including timely access to quality emergency obstetric care if needed.

3. All women and newborn must have access to post-natal care soon after delivery.

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Why Are They Dying?

Source: Lancet Countdown Coverage writing group, Lancet Countdown special issue, 2008

Continuum of Care is missing

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We looked at the magnitude of:

HIV/AIDS

Maternal Health We discussed some key strategies. The next steps is to explore the roles

and responsibilities of Pharmacists

in implementing the strategies.

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Perceived as lethal & incurable

Perceived to be the responsibility of the affected.

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Prevention- reduced access to service Treatment- fear of disclosure of status to

staff, not waiting to be seen at the clinic. Research- concerns of loss of

confidentiality Not wanting to identify as a member of a

stigmatized group Care- unwilling to provide care for the

sick family members. Mental Health- high rates of depression

and suicide.04/21/23 27

Effective action requires understanding of:

What is HIV/AIDS related stigma and discrimination.

How do the 2 relate

Where do they occur & what is their impact

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Quality/Qualities that discredit - the individual or community.

A process of devaluation- unworthiness.

Does not naturally exist - It is created through social construction

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Reinforces earlier prejudices: Builds upon, plays into – especially gender, sexuality and race.

Power and control relations: Produces/reproduces

Social inequality: creates and is reinforced

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An act or omission, that harms or denies services or entitlements based on their HIV status.

Distinction made based on known or presumed HIV/AIDS status that results in unfair and unjust treatment.

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In practice - a trickle cause & effect:

● Vicious circle

● One leads to the other

● They reinforce and legitimize each other

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● Multi-pronged action

● Sustained over time.

● Inter-dependent

● Mutually reinforcing

● Consequences: Responses in one setting impact another setting

● Address structural issues: Values and expectations of communities and society

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● Stigma: solidarity, tolerance, understanding, respect at community level.

● Discrimination & human rights violations: - Laws and policies: to protect against

discrimination - Advocacy: promotion and protection the rights of

people living with HIV/AIDS and marginalised groups.- Accountability: Enforcement of the law & ensuring

redress04/21/23 35

● Involvement of People Living With HIV/AIDS.

● Counselling and support to HIV/AIDS-affected families, including children, through ‘succession planning’

● Creating a supportive and confidential space for the discussion of sensitive topics - HIV/AIDS hotline.

● Mobilising community leaders to encourage greater openness around sexuality and HIV-related issues within communities by building on positive social norms.

● Raising awareness through the media.

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● AIDS Integrated Programme

● Mobilising religious leaders

● AIDS education

● Addressing broader inequalities

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These tend to address institutional settings.These include:

● Mobilising workplaces to implement non-discriminatory policies.

● Promoting understanding about HIV/AIDS through education of managers and employees.

● Improving the quality of care in health services for patients living with HIV/AIDS.

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● Instituting legal action to challenge violations of human rights.

● Promoting understanding among people living with HIV/AIDS of their rights.

● Advocating for increased access to HIV/AIDS treatment.

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● Increased willingness of relatives and community members to care for HIV-positive people

● Increased willingness of community members to volunteer in

HIV/AIDS prevention and care programmes

● Increased disclosure of seropositivity by people living with HIV/AIDS, and their increased involvement in, and leadership of, prevention, care and advocacy efforts

● Reduction in self-stigma and increased confidence among people

living with HIV/AIDS; and

● A more open expression of positive attitudes within communities towards people living with, and affected by, HIV/AIDS.

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● Increased uptake of HIV counselling and testing ● Increased access to and uptake of treatment ● Reduced numbers of complaints by people living

with HIV/AIDS and their families

● Improved quality of care of HIV-positive patients, resulting in enhanced quality of life

● Increased willingness on the part of health

workers to deal with people living with HIV/AIDS

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● Reduction in complaints of discrimination

● Increase in volunteers within workplaces for specific HIV/AIDS programmes

● Increased ability to be open about status by HIV-positive employees

● Increased willingness of employees to work alongside people known to be living with HIV/AIDS

● Enhanced uptake of treatment services offered by workplaces.

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● Responses are inadequate : programmes are not addressing underlying structural (social, economic, political) determinants of HIV/AIDS related stigma and discrimination

● Private settings not addressed: Discrimination that frequently occurs in contexts and settings not covered by policies or legislation, such as within families and everyday social encounter.

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are seen as

Sex workers, injecting drug users, other marginalized groups are seen as

responsible for

HIV/AIDS

People living with HIV/AIDS

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