1. Women with HIV/AIDS in Sub-Saharan Africa Sarah Bransford, Love Odetola, Laurel Oswald, Erick Marigi, Jack Schechinger

2. The Problem

3. Aids Fact Sheet Sub-Saharan Africa Population: 926,000,000 people People living with HIV/AIDS: 25,000,000 people o 69% of the worlds HIV/AIDS carriers live in SSA Women (aged 15+) with HIV/AIDS: 14,750,000 people o 59% of carriers, and 70% of young people carriers Children with HIV/AIDS : 2,900,000 people AIDS deaths in 2012: 1,200,000 people * All stats are as of 2012 and newer from UNAIDS

4. Biological Reasons Transmission from man to woman is easier larger area of vaginal epithelium transmission of larger volume of genital fluids --higher viral load in semen Malaria increases HIV infection increases viral load 7-10x

5. Biological Reasons Parasites deplete nutrients through intestinal loss and chronic diarrhea Schistosomiasis worms in lakes and streams produces genital lesions

6. Malnutrition Increases susceptibility to HIV by lowering immune function 19 of the 21 worldwide famines Females more vulnerable deficiencies in macro (proteins) and micronutrients (vitamins) Higher risk of infection

7. Food insecurity o More likely to engage in risky sexual practices o Sex as a means for money o Worry over food, inadequate quality, inadequate quantity, or acquired through socially unacceptable means Malnutrition

8. Low Socioeconomic Status Associated with a higher risk of HIV in women Studies show riskier sexual behavior Lack of safe transportation to and from school Wealth correlated with increase in risk for both sexes o Poverty disproportionately increase risk for women

9. South African Study o Low income households associated with earlier loss of virginity o High probability first encounter forced o Increased rates of transactional sex Low Socioeconomic Status

10. Education ●According to the World Bank 17.4 million girls are not enrolled in primary school compared to 14.8 million boys in Sub Saharan Africa ●Why do girls drop out? ○Typically poor ○Fall behind during menstruation ○Gender inequality ○Rural communities

11. Education Implications ●Higher education in girls & women leads to increased: ○Age of first sexual encounter ○Condom use ○Family Planning ○One sexual partner

12. Gender Inequality Men hold the power in Sub Saharan Africa: ●Economic: Bride payments or economic inferiority ●Social: Men often have multiple partners ●Sexual: Men often make the final decisions about family planning

13. War - HIV & Maternal Health Rwanda (1994): 200,000 - 500,000 rapes UNICEF: 80% HIV positive among female rape victims Rape: Increases risk of HIV infection High HIV prevalence population mix with low prevalence population!

14. Intimate Partner Violence and HIV 40% - 45% of violent relationships include forced sex. Forced sex -> Vaginal/Rectal lacerations that increase likelihood of HIV transmission. Rape increases women's HIV risk infection by 30%.

15. Intimate Partner Violence and HIV Ex: Tanzanian men who act violently in relations are 1.8X more like to have pre/extramarital sex. Leads to more HIV transmission. Abused women: decreased immune system.

16. Millennium Development Goal 5 5A: Reduce by three quarters the maternal mortality ratio 5B: Achieve universal access to reproductive health

17. Case of Eritrea -Once had highest maternal mortality rates (1,400 deaths per 100,000 births) -One of four African countries on track with Millennium Development Goal 5 -each community now has trained maternal caregivers who visit homes

18. Recap Question: Why are women more predisposed to contract HIV/AIDS in Sub-Saharan Africa o Biological Reasons o Conflict and War o Gender Inequality and Education o Malnutrition and Socioeconomic status

20. Sub-Saharan Africa AIDS Challenges 1.National and community development 2.Enabling individuals to protect themselves 3.Providing health care and treatment Picture of Chief Chikanta at a voluntary counseling and testing (VCT) sign in Zambia *http://www.avert.org/images/5165-chief-chikanta-vct-sign- zambia

21. National and Community Development Impact of HIV/AIDS on a country o Strains health sectors - resources and finances o Affects labor- most HIV/Aids affected are in working prime o Significantly slows down economic growth and development Progress o Increasing international and requiring domestic funding  developing infrastructure, promoting self sufficiency o Focusing on women with HIV  Microbide treatments, and education o Reducing HIV-related stigma and discrimination

22. Self protection from HIV/AIDS Prevention is the goal Condoms o Cheap and cost effective o Social, cultural, and practical (pregnancy) factors deter use M essage from BVI Nurses Association about HIV prevention http://www.avert.org/hiv-and-aids- africa.htm#sthash.oQ6hGMQR.dpuf HIV Testing o Provision of voluntary HIV counseling and testing (VCT) program o Rapid HIV testing  same day test and diagnosis

23. Providing health care and treatment Antiretroviral drugs (ARVs) o delay the progression of HIV to AIDS o Distribution of ARVs require money, health systems, and workers Problems o Access to care, for many Africans with HIV, ARVs are not available o Children with HIV are less likely to receive ARvs than adults (21%) o Poor healthcare infrastructure and lack of and funding Progress o Notable increase in ARV access 49% in 2010 -> 56% in 2011 o Treatment offered for opportunistic infections o Aids Treatment Video Aids Treatment Video

24. Connection to class content Crisis vs. Protracted Crisis “In war, or natural disaster, humanitarian medicine intervenes to minimize the effect of the crisis on human health through medical intervention.” Acute crisis “the best we can possibly do” Should we consider HIV a worldwide neglected emergency?