HIV-related stigma might be responsible for a quarter to half of the cases of transmission of HIV from mother to child, according to preliminary findings by the International Center for Research on Women (ICRW) and the London School of Hygiene and Tropical Medicine.
Researchers also found that a highly effective stigma-reduction program could potentially curtail infant infections by as much as 33 percent.
The exploratory analysis – a first of its kind – attempts to quantify how stigma undermines HIV programs and explores the cost benefits of programs to reduce HIV-related stigma. ICRW and the London School focused their analysis specifically on efforts to prevent mother-to-child transmission of the virus.
“We believe this is a significant initial step toward counting the cost of doing nothing to reduce stigma,” said ICRW expert Laura Nyblade, who helped conduct the research. “Many pregnant women who are HIV-positive drop out of these programs or don’t adhere to medical protocols because of a variety of social barriers, including stigma.”
The World Health Organization estimates that about 430,000 children were newly infected with HIV in 2008. Most of them acquired the virus through their mothers during pregnancy, delivery or while they were being breastfed.
However, the risk of HIV being passed to newborns can be drastically reduced when both mothers and babies take antiretroviral medicines and where certain infant feeding practices are followed.
The ICRW and London School analysis is based on a summary of current evidence on stigma’s impact on HIV programs. That information helped develop a mathematical model that attempts to quantify the potential influence and cumulative impact of stigma on prevention of mother-to-child HIV transmission programs. For the model, researchers considered various levels of stigma and the different scenarios women face – such as a lack of transportation to a health facility – that can contribute to their inability to participate in prevention programs.
The findings suggest that an investment of $1 to $10 in each woman attending prenatal care could potentially reduce the number of infants infected with HIV. The larger investment could be cost-effective in settings where HIV is more prevalent.
“We can provide as many services as we want,” Nyblade said, “but if we do not invest in reducing stigma, we’re not going to reach all those who need them the most.”
Paul DeLay, deputy executive director of UNAIDS, echoed a similar sentiment during a recent forum in India about HIV prevention efforts.
“Everyone in the AIDS response is looking for the game changer that will radically improve our impact,” DeLay said. “Most of the focus has been on biomedical breakthroughs, like a vaccine, a cure, an effective microbicide, using treatment as prevention. We do need all of these. But the true game changer is reducing stigma.”
For further reading, download the working paper, "Modelling the Impact of Stigma on HIV and AIDS Programmes: Preliminary Projections for Mother-to-Child Transmission."
Gillian Gaynair is ICRW's writer/editor.