Scaling up HIV/AIDS care among women in Sub-Saharan Africa: Cross-cultural barriers

Abstract

The HIV/AIDS epidemic wears a predominantly female face as evidenced by the exceptionally high women's vulnerability to HIV infection particularly in the sub-Saharan Africa (SSA) region. Women and girls continue to be affected disproportionately by HIV infection relative to men and boys, and they account for approximately 60 % of the estimated HIV infections worldwide. Women in the developing world confront serious socio-cultural, economic, and gender disadvantages that influence the dynamics of HIV/AIDS among females. It is critical, therefore, to have strategies to expand culturally appropriate and acceptable prevention and care for women especially in the developing world. In this chapter, we review the cross-cultural perspectives, norms, and practises around motherhood that present unique challenges to the scale-up of HIV prevention, care, and treatment interventions in SSA. We consider socio-cultural issues surrounding pregnancy and childbirth, family planning and infertility, disclosure of HIV serostatus and HIV sero-discordance, conflict and war, and how these have affected the uptake and scale-up of HIV/AIDS prevention, treatment, and care programs. We tackle specific vulnerable groups of girls/women such as adolescents and orphans and how these groups have increased vulnerability to HIV infection in the African sociocultural context.We also highlight some strategies to make the current prevention, care, and treatment interventions adaptable to the specific socio-cultural boundaries encountered by the cross-cultural HIV/AIDS epidemic. Women's access, uptake, and adherence to comprehensive HIV/AIDS prevention and treatment/care programs including prevention of mother-to-child transmission of HIV (PMTCT) and highly active antiretroviral therapy (HAART) are hampered by numerous socio-cultural constraints including socio-economic status, power and gender inequalities, male dominance of women's decision-making processes, and continuous strive of women to conform to society expectations as well as the prestige surrounding motherhood. In order to reach all the women in need of HIV/AIDS care and change the tide of the HIV/AIDS epidemic, the prevention care and treatment interventions should be tailored to address the socio-cultural perspectives, norms, and practises of the communities affected by the epidemic. We recommend a large base of operational research in the different sociocultural settings in order to develop evidence-based local solutions for site-specific problems.