THE WELLBEING OF GIRLS AND WOMEN IN THE CONTEXT OF HIV and AIDS.
Women and girls make up half of the world’s population. They also fall in the category of the wolrd’s 70% poor and illleterate (can’t read or write). Studies have shown that girls and women are impacted negatively by the socio-cultural, psychological, economic and political factors individualy as well as collectively in homes and commuities. This was echoed by Glenys in her speech delivered to the Royal College of Obstetricians and Gynaecologists on the topic “women’s rights to health and well being” (March 10, 2014). “...The health and well being of women and girls in developing countries continue to be imperilled by the plain fact that they are female. She notes that the health and the wellbeing of women and Girls is a useful inidcator of the health of a society. She adds that one can tell about a country’s current and future prospects by examining among other things the lifetime risk of maternal death, percentage of women using modern contraceptives and women’s literacy rate, their participation in national growth and enrollment of girls in school.
Women in rural sub-saharn Africa, struggle to gain access to basic reproductive health care, antenatal and postnatal care. The situation is even made worse if they are HIV positive.
More than 34 million people are estimated to be living with HIV globally, and 67%of them reside in ‘Sub-Saharan Africa’. And whereas 16 million are eligible for antiretroviral therapy (ART), only 8 million people in resource limited countries were reported to have been receiving antiretroviral ART at the end of 2011(WHO/UNICEF.2011).
The Ministry of Health Kenya reported in August 2013 that 1,6 million people(6.3% of the population) are living with HIV, and as of March 2013, of the 850, 000 people in need of treatment, 614,400 people were actively on ART(NASCOP,2011). Currently an estimated 70% of patients on ART in Kenya are managed in about 30% of health facilities nationwide. This poses a very big demand to the facilities in terms of human resources, infrastructure and other needed resources (Ministry of Medical Services and Ministry of Public Health Sanitation, 2012).
Studies have shown that ART is effective in suppressing viral replication as intensely as possible and as long as possible. ART also reduces HIV viral load to undetectable levels, restores and preserves immunological functioning, reduces opportunistic infections, improves the quality of life of PLWHAs, and reduces HIV related sicknesses, deaths and reduces the impact of HIV transmission in the community. ART is therefore used mainly to treat the established HIV infection among PLWHAs, and to prevent HIV infection in expectant mothers, after occupational exposure, and after rape or sexual assault.(Van Dyk.2008.95).
HIV treatment programs in resource limited settings have immensely contributed to HIV prevention efforts since their inception. Studies have shown that the Antiretroviral (ARV) drugs used to improve the health of People with the human immunodeficiency Virus(PLWH) also lower the risk of transmission of HIV to HIV negative people, uninfected partners among discordant couples and children in pregnant and breastfeeding women. Research has also shown that ‘ART use in PLWH also reduces morbidity and mortality. However, there are still needs in the area of patient retention, adherence and sustenance particularly at the community level.
Some hardly get access to antiretroviral therapy or PMTCT services which is one of the key areas of universal acces to healthcare. As a result of the above, mortality and morbidity rates among women and their newborns is high in developing countries. Many women die during delivery and after delivery especially caused by haemorheage, and birthing complications such as delayed labour and reaching the facility late. With regard to this important matter of maternal health, WHO has observed;
Globally, an estimated 289 000 women died during pregnancy and childbirth in 2013, a decline of 45% from levels in 1990. Most of them died because they had no access to skilled routine and emergency care. Since 1990, some countries in Asia and Northern Africa have more than halved maternal mortality. There has also been progress in sub-Saharan Africa. But here, unlike in the developed world where a woman's life time risk of dying during pregnancy and childbirth is 1 in 3700, the risk of maternal death is very high at 1 in 38. Increasing numbers of women are now seeking care during childbirth in health facilities and therefore it is important to ensure that quality of care provided is optimal. Globally, over 10% of all women do not have access to or are not using an effective method of contraception. It is estimated that satisfying the unmet need for family planning alone could cut the number of maternal deaths by almost a third (WHO uptades. May 2015).
Inspite of the worldwide achievement in Maternal health, we still see that efforts to reach the MGD goal 5 on reducing Maternal mortality and chieving universal acces to reproductive health by 2015 is far from being realised in Africa.
Africa accounts for half of all deaths of children under five. It is approximated that 800 women die every day in Africa from preventable causes related to pregnancy and childbirth. Others suffer complications leading to disabilities as noted earlier that may limit their quality of life and that of the surviving children. It has also been noted that children in Sub-Saharan Africa are 16 times more likely to die before the age of five than those in developed regions (GHRI.2014). South Africa looses 4,300 mothers due to complications of pregnancy and child birth, 20,000 babies are still born and another 23,000 die in their first month of life.in total, 75000 children, do not make it to their fifth birthday(www.unicef.org/south Africa .
In Kenya Maternal mortality remains high at 488 maternal deaths per 100000 live births. While this is below the sub-Saharan average of 640 deaths per 100000 live births, Kenya experiecnes a very slow progression in maternal health (MCH/WHO. 2011). Most maternal deaths are due causes directly related to pregnacny and child birth unsafe abortion and obstetric complications such as servere bleeding infection,hypertensive disorders and obstructed labor.over 7 million children under -5years of age in kenya die each year mainly from preventable conditions(KHDS.2008-2009).
Kenya had committed to reduce maternal mortlity rates by 147 per 100000 live births, but despite the committment to maternal child health care, kenya continues to make slow progression in this regard. With 488 deaths per 100 000 live births, the country is off track in achieveng the UN Millenium Development Goals 4 and 5 by 2015.
The Latest strategic frameworks geared towards promotion of matrnal and new born and child health in Kenya ar spearheaded by her excellecncy, the First Lady of theRepublic of Kenyan Margaret Kenyatta through Beyond Zero campaign(www.beyondzero.or.ke).
Even so, there is still a huge need for the mobile MCH services in hard to reach rural areas in kenya. Every effort is supposed to be geared towards supporting this noble task of beyond Zero campaign, and UN’s Millenium development goal 4 and 5 in kenya and the world at large.
This is why WHO is keen in pointing out the key areas as outlined below that need to be addressed to ensure there is reduction in Maternal mortality and ensuring acces to universal reproductive health;
WHO key working areas:
Strengthening health systems and promoting interventions focusing on policies and strategies that work, are pro-poor and cost-effective. Monitoring and evaluating the burden of maternal and newborn ill-health and its impact on societies and their socio-economic development. Building effective partnerships in order to make best use of scarce resources and minimize duplication in efforts to improve maternal and newborn health. Advocating for investment in maternal and newborn health by highlighting the social and economic benefits and by emphasizing maternal mortality as human rights and equity issue. Coordinating research, with wide-scale application, that focuses on improving maternal health in pregnancy and during and after childbirth.
Adolescent girls face a number of challenges among them sexually transmitted infections, maternal deaths, female cuts and eventual severe bleeding, forced or early marriages and sexual assault, all of which have pivotal implications to girls growing up.there existed traditional systems in sub-saharan Africa that took care of sexual education for girls growing up, and protected virginity of girls but have since died with mordenity and industrialization of scociety. Poverty has also compromised women and girls as the choice to servive and put food to the table in poor households makes the women and girls in these poor communities vulnerable to sexual exploitation in excahnge for money to sustain poor households. This exposes the women and girls to infections and early deaths in pregnancy or childbirth.
In Africa, the other sickening factors making women and girls vulnerable are conflict and war, especially when they make the instruments of war. All these have impacted negatively to girls as they struggle with sexual assault, early or forced marrieages, female cuts, teen pregnancies and sexually transmitted infections, among them HIV.
Young people are key in HIV prevention through out the world. Therefore we need HIV care and prevention programmes that are girls and young women friendly. Sexual and reproductive health of young women and girls living with HIV should be very important components of health care in Africa.
Gender based Violence against women and girls in conflict and non-conclift regions in Africa affect women negatively. The mental torture, physical pain, infections and pregnancies are traumatic for women and girls. As result the need for help is high. Psychosocial care and counselling comes in handy for the women and girls to help in post traumatic disorders that develop sometime after the rape ordeal. They also need medical care to address the sexually transmitted infections, and the bruising during the rape encounter.Women and girls would need ART and Anti-bacterial medications and pain relievers.Psychological care is vital incases of HIV infection to address loss, grief, stigma,blame, ostracism, rejection, and suicide among women and girls, even way after the event has happened.this further promotes the emotional and mental well being of women and girls who fall victims of sexual assault. Assaulted women and girls also need legal support for effective protection and eventual justice to ensure perpatrators of such henious acts face the full force of the law.
Promote a rights and just culture in the world as women health, and safety is their human rights that need to be protected. Address all the negative cultural and structural factors that risk girl’s and women’s health. Promote harmony and peaceful co-existence to reduce or eliminate hostility in developing countries To reduce or eliminate funding terrorism or conflict in war torn areas in africa, and integrate peace in all activities of development Upgrade maternal and reproductive health care services from grassroots Eliminate HIV stigma and discrimination in homes and communities
· Reduction of poverty by econmically empowering households where women play pivotal roles
· Empower women and girls who are burdened with care in communities with information and IGAs. For women involved in formal institutional care, there is need to train them and enable them access and used vehicles and motorcyles in follow up of the sick in coomunities
· Promote teen friendly sex and sexuality services for empowerment and acces to health care
Address the historical and traditional factors that have fueled conflict and wars that impact women and girls negatively. Promote the holistic approach to the wellbeing of women and girls by ensuring social,religious, economical,political and cultural factors that feed into making women’s ill health a daily reality are urgently addressed at all levels of societies. International orgainzations and world goverments ought to put structures in place to ensure safety of girls and women in homes and communities.
As for the perpatrators of henious acts as rape, killing, mutilations and sexual crimes, measures need to be put in place for them to face the full force of the law, and for justice to victims-non discriminatory access to health care. This will in effect prevent permanent disabilities and deaths of women that are uncalled for as a result of lack of acess to competent health care practitioners. Therefore institutions and relevant governments ought to create and put in place programmes and structures that identify, acknowledge, protect and promote sexual and reproductive health and rights of girls living with HIV and AIDS. In particular, African countries should promote the culture of participation of women and girls living with HIV in formulation and implementation of HIV policies and rights initiatives and form and strengthen friendly grassroots support around women, girls and their families.
United Nations, 2011. The millenium Development Goals Report 2011. New york.UN
Beyond Zero campaign(www.beyondzero.or.ke
Van Dyk, A. 2008. HIV/AIDS care and counselling: a multidisciplinary approach. Capetown.
Kenya Demographic and Health Survey(KHDS) 2008-2009.
Kenya. Neonatal and child health profile(2011): MCH/WHO.
Global Health Policy.2014. Global Health Research Initiative.Global Health
World Health Organizations, 2012b. Trends in Maternal Mortality 1990-2010nGeneva WHO.
Ronsmans C, Graham WJ. 2006 Marternal mortality: who when,where and why. The Lancet(1189-1200).
UNICEF (www.unicef.org/south Africa .accessed in May 2015
Glenys “women’s rights to health and well being” (March 10, 2014). Royal College of Obstetricians and Gynaecologists
 In the Regional HIV/AIDS statistics and features, UNAIDS (2012) estimates the figures to be 25.0 million (23.5 million-26.6 million) adults and children infected in Sub-Saharan Africa.