Assumptions were not made by all of the researchers, however when assumptions were made they varied across the publications. It was assumed that HIV testing and perinatal treatment would have no effect on transmission through breastfeeding; in other words the percent of children who are not infected at birth will become infected later through breastfeeding, regardless of testing and perinatal treatment (Stoto & Goldman, 2003). It was also assumed that although acceptance of testing and counseling by mothers was low in field trials it would improve in a National program (Stoto & Goldman, 2003). In projecting that 54 percent of all hospital beds will be occupied by AIDS patients in 2005 because 47 percent were occupied by AIDS patients in 2003 the researcher assumes that the number of hospital beds available in 2003 will remain constant (Garbus, 2003). Other assumptions include researchers assuming an expected proportion or participants’ knowledge of HIV/AIDS and testing of 50 percent and a 3.2 percent margin of error in order to calculate their sample size (Alemu et al., 2004). In addition, researchers assumed that there would be no risks in delivering prevention interventions for MTCT of HIV because they didn’t project any problems with maternal and child health services (Preble & Piwoz, 2001). Lastly, it was assumed that only those who perceive themselves to be at risk for HIV/AIDS would want to be tested and that the number of people that wanted to get tested would equal twice the number of people living with HIV/AIDS (WHO, 2002). None of the researchers made assumptions based on the same contexts, however the assumptions that were made were representative of the studies conducted and claims made.
Overall, only three of the publications made concrete hypotheses or claims and tried to prove them through research and different studies. One of the more obvious claims was that voluntary counseling and testing (VCT) is a potentially effective intervention to prevent transmission of HIV by changing sexual behavior, and also enabling HIV positive women to make informed decisions about whether or not to have children (Alemu et al., 2004). Another similar claim presented was that through comprehensive maternal and child health (MCH) services including prenatal, antenatal and child health, accessible VCT and support for safe infant feeding that MTCT will be greatly reduced (Preble & Piwoz, 2001). In addition, it was claimed that if the prevalence of HIV in a group of childbearing women is high enough, 15 to 20 percent, an antenatal or after birth, HIV screening program can even save money for the health care system and assist in decreasing HIV infections in children (Stoto & Goldman, 2003). Other claims include that reduction of MTCT of HIV can be reduced significantly with the use of medications, through increased knowledge about prevention and care (Alemu et al., 2004; Garbus, 2003; Preble & Piwoz, 2001; Stoto & Goldman, 2003). These claims are not answered directly in all cases, but the conclusions found are representative.
The major conclusions and findings from these publications have many similarities and a few differences. Overall, the researchers concluded that there are effective and practical strategies to prevent loss of life due to HIV infection in children including, HIV positive pregnant women being treated with a simple course of antiretroviral drugs before, during, and after birth (Alemu et al., 2004; Garbus, 2003; Preble & Piwoz, 2001; Stoto & Goldman, 2003). In addition, affected infants can be treated, and alternatives to breastfeeding can also reduce the rate of transmission (Stoto & Goldman, 2003; WHO, 2002). These interventions can substantially reduce the risk that children will be born with HIV infection which is necessary because nearly 90 percent of African children infected with HIV do not survive beyond their third birthday (Stoto & Goldman, 2003). It’s concluded that child bearing starts early in Ethiopia (Garbus, 2003) which leads to findings that an average of 16 percent of women ages 15-19, 1 percent at age 15 and 40 percent at age 19, have already become mothers or are currently pregnant with their first child (Garbus, 2003; MOH, 2004). When HIV-infected mothers breastfeed their babies, the overall benefits of efforts put forth to prevent transmission are diminished (Stoto & Goldman, 2003) yet, 71.5 percent of women said that they would continue to breastfeed, even if they were infected (Alemu et al., 2004). According to different sets of data, the group with the highest HIV prevalence in Ethiopia is women ages 15-24 (Garbus, 2003; WHO, 2004; MOH 2004). Of the pregnant women tested for HIV, 13.2 percent tested positive (Garbus, 2003; UNAIDS, 2004; WHO, 2004). Only 50 clients received (PMTCT) preventive MTCT services in Ethiopia during 2001 mostly do to that there were only three public sites providing basic PMTCT services ( Garbus, 2003; WHO, 2002). Knowledge based studies have concluded that the major knowledge gap is mother to child transmission of HIV (Alemu et al., 2004; Garbus, 2003; MOH, 2004; Preble & Piwoz, 2001; Stoto & Goldman, 2003; Yerdaw, Nedi & Enquoselassie, 2002). In one study only 58.2 percent of women knew that HIV can be transmitted from mother to child (Garbus, 2003) and in another study 75.1 percent of adults knew that HIV could be transmitted from mother to child (Alemu et al., 2004). Finally, the studies concluded that stigmas related to HIV/AIDS in Ethiopia are very negative and due to this people have conflicts with getting tested, informing others in order to prevent transmission and wanting to get treatment, especially pregnant mothers (Alemu et al., 2004; Garbus, 2003; Preble & Piwoz, 2001; Stoto & Goldman, 2003; WHO, 2002; Yerdaw et al., 2002). These findings create a strict pattern that must be followed in order for prevention of MTCT of HIV/AIDS to be successful.
Research has proven that certain things work and others don’t. From the research considered in this analysis I have been able to identify the prevention methods that would be best in trying to lessen the amount of MTCT of HIV in Ethiopia. Women have a higher HIV/AIDS prevalence rate than males in Ethiopia. In addition, the highest rate of HIV/AIDS infection is shown by women from the age of 15 to 24. Over half of these women that are infected will become pregnant before they even leave this age range. Of the 128,000 infected pregnant women who gave birth in 2003 about 35,000 passed the infection on to their new born at some point. Many of the mothers did not receive treatment for a number a reasons, but a large issue involved with the lack of treatment is the stigma attached with HIV/AIDS in Ethiopia. The disease is strongly looked down upon which makes people not want to disclose that they are infected. In refraining from letting anyone know that they are infected, people are adding to the devastation that is already occurring from the HIV/AIDS epidemic. Since the number of infections from MTCT has been steadily increasing over the years it is imperative that we educate women quickly. It has been shown that only 50-75 percent of woman realize that HIV/AIDS can be transmitted from mother to baby. We need to focus on the fact that most Ethiopian women believe that they should breastfeed their child and come up with interventions to assist in preventing HIV positive mothers from breastfeeding because the medicine can’t prevent the transmission from breastfeeding. It has been show that the medicine can create a 50 percent drop in transmission rates when given during birth. The medicine is inexpensive and seems to be the best prevention mode available. When the mother is in the hospital it would be easy to ensure that she received the medicine properly, however a large number of births, mostly in rural areas, are done in the home. This is where targeting the knowledge of reproductive age women is key to our campaign. If they are well informed on the subject they will be able to make better decisions, especially if they are infected and not yet pregnant. This is important because we need to not only focus on preventing transmission after the mother is pregnant, but also on informing the potential mothers about the dangers of becoming pregnant if they are HIV positive. This is only one mode of transmission, but it is considered to account for 20-25 percent of new infections, so focusing attention on this can assist in raising the societal and economical levels back to where they should be. More infections create more people needing to use health services and treatment of AIDS is more expensive than other health treatments. In addition, it is hard to work when you are infected so you loose money. Families that have members that are infected with HIV/AIDS generally make less money and spend more on treatments and healthcare than the health families. In summary, to ensure that our campaign is successful and reaches the most people possible we have to consider all avenues available. I suggest that we focus on finding ways to provide knowledge through interventions and try and alleviate the stigma that is involved with the disease. If we can make them feel comfortable about the situation they are in and provide them with the right knowledge and resources a decrease in MTCT of HIV will be noticeably reduced.
References
Alemu1, S., Abseno, N., Degu1, G., Wondmikun, Y., Amsalu, S. (2004).
Knowledge and attitude towards voluntary counseling and testing for HIV: A
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Garbus, L. (2003a). HIV/AIDS in Ethiopia. Country AIDS Policy Analysis Project.
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Preble, EA., Piwoz, EG. (2001). Prevention of mother-to-child transmission of hiv in
africa: practical guidance for programs. SARA Project.
http://www.dec.org/pdf_docs/PNACM052.pdf
Stoto, MA., Goldman, AS. (2003). Preventing perinatal transmission of HIV.
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MOH, (2004). Fifth report: Aids in Ethiopia. Disease prevention and control
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