HIV/AIDS in women of reproductive age in sub-Saharan Africa; An Overview

By Chika Jones. Freelance writer and Datelinehealth Africa (DLHA) volunteer. Medically reviewed by: Nr Chinonso Cynthia Ukah. BNSc, RN, RM.

Image of a group of reproductive age African women with the HIV/AID ribbon overlaid.

Highlights

• Globally, 44% of all new HIV infections were among women and girls (all ages) in 2023.

• African women are considered to be one of the most vulnerable populations in the world for HIV/AIDS.

• In sub-Saharan Africa, women of all ages and adolescent girls accounted for 62% of all new HIV infections.

Introduction    

The human Immunodeficiency virus (HIV) is a virus that targets the immune system especially the white blood cells. The white blood cells serve an important protective function against diseases and infections in the body. HIV attacks the white blood cells, specifically the CD4 cells which are the chief protection cells in the immune system and the virus depletes the number of the CD4 cells in the body.

Your level of the immune system is measured by the CD4 cell level count.  When HIV attacks the CD4 cells, it makes your immune system susceptible and puts you at risk for opportunistic infections like tuberculosis, human papillomavirus (HPV) etc., and cancers.

When HIV progresses to an advanced stage it is referred to as Acquired Immunodeficiency Syndrome (AIDS). 

The WHO now defines Advanced HIV Disease (AHD) as CD4 cell count less than 200 cells/mm3 or WHO HIV/AIDS stage 3 or 4 in adults and adolescents.

HIV/AIDS currently has no cure but Antiretroviral Therapy (ART) is taken to control it from advancing from one stage to the next. The main goal of ART is to slow the progression of HIV into AIDS and reduce the viral load - a test that measures the amount of HIV in the blood.

Risk Factors

Anyone can be predisposed to HIV, especially women and this is without regards to race or geographical location.  Studies show that women are more likely to get HIV infection than men because of the greater mucosal area that is exposed to HIV during penile penetration. Because of an underdeveloped cervix and low vaginal mucus production, adolescent girls and young women between the ages of 15 - 24 are at an even greater risk of acquiring HIV. 

Other risk factors of HIV/AIDS include:

• Engagement in unprotected sexual intercourse – oral, anal or vaginal sex

• Sharing needles for injections especially among drug users

• Accidental needle pricks from an infected HIV person to a healthcare worker

• Having multiple sexual partners

• Vertical transmission – i.e., transmission of HIV/AIDS from a mother to her child during pregnancy, labour or breastfeeding

• Co-occurring sexually transmitted infections (STIs) like syphilis, gonorrhea, chlamydia, herpes, and bacterial vaginosis increases the chance of contracting HIV/AIDS. The reason for this is complex.  

It is important to emphasise that HIV cannot be transmitted through kissing or sharing spoons with an infected person.

Symptoms

People with HIV/AIDS go through stages of infections and each stage shows a different clinical appearance. During the first few months people with HIV are more infectious but many are unaware until later stages.

1. Acute HIV Infection stage

This stage appears as flu-like symptoms and usually lasts from 2-4 weeks. This stage is highly infectious as there is an increased amount of HIV in the blood and bodily fluids e.g., vaginal secretions, etc. Around 50% to 90% of people who are infected develop early symptoms of HIV. The symptoms include 

• Fever 
• Muscle and joint pain
• Sore throat 
• Swollen lymph nodes
• Weight loss
• Nausea and vomiting 
• A generalized rash around the chest, neck and face. It usually occurs from the fifth to eighth day

2. Chronic HIV Infection stage

This stage is also known as asymptomatic HIV infection or clinical latency. This is because HIV is still in the white blood cells but many people don’t show infections or diseases that HIV can cause. The stage usually advances into AIDS ten years or later. It may advance faster without ART. African women who take their ART during this stage exactly as prescribed can be in this stage for several years. It is possible to transmit HIV at this stage but women who use ART consistently and maintain an undetectable viral load pose no threat of transmitting it to their HIV-negative partner.

3. AIDS 

This stage is the most advanced and the immune system is severely weakened and prone to infections and cancer. Common symptoms seen at this stage include

• Skin blotches 
• Prolonged diarrhea 
• Rapid weight loss
• Memory loss
• Depression 
• Recurrent fever
• Pneumonia 
• Other neurological disorders

Diagnostic test

The CDC recommends that everyone between 13 – 64 ages should include an HIV test as a routine health checkup. HIV is diagnosed through blood or saliva test and it has three tests that are carried out. No HIV test carried out can detect HIV immediately after an infection due to the window period. A person’s immune system when exposed to HIV takes time to produce antibodies to fight against it. The timeframe from when one is exposed to the virus till when it can be detected is termed the window period. This period varies from one person to another.

1. Antibody test

This test is used for the HIV rapid diagnostic self-kit that one can perform by themselves at their convenience. An antibody test looks for antibodies present in the blood or saliva. Antibodies are produced by the immune system when exposed to HIV. It takes 3-12 weeks for a positive antibody test result.

2. Antigen- Antibody Test

This test is done in the lab and requires drawing blood from the finger. Antigen-Antibody test searches for HIV antigens and antibodies. Antibodies had been discussed earlier; antigens are the substances on the HIV itself. HIV antigens are used to tell if HIV is present in one after an exposure. A positive result will not come out during 2-6 weeks.

3. Nucleic Acid Test (NAT)

NAT is more sensitive than other HIV diagnostic tests. It can detect the viral load hence it is also referred to as viral load test.  NAT detects HIV within 10-33 days and is considered for monitoring HIV treatment. The test is carried out in the lab but due to the expensive nature, it is not considered for routing screening.

Impact of HIV/AIDS on women's reproductive health

WHO defines reproductive health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. This means that a woman has the right to have sex with her partner(s) without any fear of being infected with HIV. This implies that reproductive health deals with a safe and healthy reproductive life including sex, fertility and family planning. 

HIV affects or can potentially affect African women’s sexual and reproductive health as detailed below

• High Risk of Cervical Cancer

Cervical cancer is caused by Human Papillomavirus (HPV), especially types 16 and 18. Cervical cancer occurs more in women during the third stage of infection (AIDS). African women living with HIV/AIDS are advised to undergo regular Pap smear tests and be vaccinated against HPV.

• Change in Menstrual Cycles 

Women living with HIV experience changes in their menstrual cycle by way of increased or missed periods. They also have a high tendency to experience menopause or hot flashes earlier than expected. They tend to experience severe premenstrual syndrome (PNS).

• Gynecological Issues 

Women living with HIV face multiple issues such as increased risk of STI, e.g., syphilis, gonorrhea, genital herpes, pelvic inflammatory disease, etc. Vaginal yeast infection occurs four or more times in a year and proves resistant to treatment for women living with advanced stages of HIV or AIDS.

• Family Planning Methods 

HIV medications can reduce the effectiveness of some hormonal family planning methods, e.g., implants, contraceptive pills, patches, or injectable, and increase the likelihood of unplanned pregnancy. Consequently, women living with HIV are encouraged to use condoms to protect themselves from unwanted pregnancy and also from acquiring STI, especially if they have multiple partners.

• Fertility  

Sub-Saharan African women living with HIV have reduced fertility due to reduced sexual intercourse and the impact of the disease. Because of low immunity, pelvic inflammatory disease is a common cause of infertility for women living with HIV/AIDS as it tends to create abscess in the ovaries. 

Prevention and control of HIV/AIDS

Role of Education and Awareness Raising

As women of reproductive age in sub-Saharan Africa share the greatest burden of the HIV/AIDS epidemic, the first and best way to prevent and control the disease, is through improved awareness and education. 

Research indicates globally that although many women of reproductive age are at risk of acquiring HIV infection, only 30% of them have comprehensive knowledge about HIV/AIDS. Another study showed most African women have heard of HIV and AIDS, but know very little about how HIV is spread or how to protect against infection. This implies that knowledge of prevention and control of HIV/AIDS is an important part of educating African women of reproductive age. 

Others

There are additional ways to prevent HIV/AIDS among women of reproductive age in Africa beyond education and awareness raising. These include:

• Condom use: Encourage the use of condoms during sexual intercourse with their partners and avoid applying oil or using expired condoms.
• Multiple partnering: Avoid sexual activity with multiple partners and where that is not feasible, encourage the regular use of condoms to protect against STI.
• Needle sharing: Avoid sharing of needles especially if you're a drug user. 
• HIV and STI testing: Regular HIV testing, routine checking for other STI and treating effectively if present.
• Abstinence promotion: Encourage younger women to abstain from sex to avoid contracting HIV/AIDS and other STI.
• Male circumcision: Educate parents of newborn male babies about circumcision and the role this plays in reducing the risk of HIV infection.
• Vertical transmission: Support activities to prevent Mother-to-Child Transmission (PMTCT). 90% of HIV infection in children less than 15 years of age occur due to mother to child transmission. The child might have been affected either during pregnancy, labor or breastfeeding. This is why CDC recommends pregnant women to take a HIV test at every pregnancy. One of the aims of PMTCT is to prevent primary infection among women of reproductive age. Primary prevention is done by creating awareness and knowledge of HIV at the individual, family and community levels.
• Pre- and Post-prophylactic antiretroviral use: Promote the use of antiretroviral drugs for purposes of reducing HIV risk before exposure and reduce load load in an infected mother after exposure. Antiretroviral drugs also help to reduce mother-to-child transmission. It reduces HIV transmission by up to 96%.

Wrap Up

HIV/AIDS is a global epidemic that affects people generally and women are more at risk of contracting the disease. National and local policy makers, public health managers, healthcare providers, organizations and all other health stakeholders in sub-Saharan Africa countries should intensify efforts at regular education and awareness raising in communities to enlighten women of reproductive age in Africa on the knowledge of HIV and AIDS; the cause, risk factors, prevention and control. Knowledge coupled with preventive action are important requirements needed to curb this disease in our society. Both require political will and funding.

Sources: 

1. Burgoyne AD, & Drummond PD. Knowledge of HIV and AIDS in women in sub-Saharan Africa. African Journal of Reproductive Health, 2008;12(2), 14-31. Abstract available from here.

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6. Teshale, A.B., Yeshaw, Y., Alem, A.Z. et al. Comprehensive knowledge about HIV/AIDS and associated factors among women of reproductive age in sub-Saharan Africa: a multilevel analysis using the most recent demographic and health survey of each country. BMC Infect Dis 2022; 22, 130.  doi: 10.1186/s12879-022-07124-9. Available from here.

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Related: The current state of HIV/AIDS prevention and care in Nigeria

Published: November 26, 2024

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