In a rural village in central Africa, my colleagues and I stood over a registration book for antenatal care clients with the goal of identifying clinic-level data that could be extracted for a project evaluation. As we made our way through the book, the left sides of the pages were filled with names of women, dates and HIV test results — it was clear that almost all of the women who tested HIV positive received some form of antiretroviral therapy (ART). As my eyes ran to the right across spaces for follow-up records, however, the fields became increasingly emptier, and our team began to discuss the various barriers to services, even a highly effective service like prevention of mother-to-child transmission (PMTCT).
Access and adherence to the greater continuum of HIV care is influenced by several factors, including community-level gender norms and related behaviors. For example, HIV-positive men may avoid HIV testing and may spend a significant amount of their income attempting to address symptoms of their illness rather than confirming their HIV status. Often, these behaviors are driven by fear that knowledge of a positive HIV test result could compromise their leadership at home and cause family instability. Research has also identified instances when men undermine their wives’ access and adherence to ART, even taking their wives’ medication for themselves. Interestingly, despite such challenges, women are more likely to access and adhere to HIV-related treatment and care than men.
The sun is setting on the Millennium Development Goals (MDGs). In 2015, the world will shift its focus toward a new development agenda. We know that family planning improves the health and well-being of women and families around the world. Now, as the next-generation goals expand the focus from social and human development to also include economic and environmental objectives, we should not underestimate the positive ripple effects of family planning across all three areas.
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It is a common belief that programs designed to increase household income will automatically have positive effects on children. In fact, the evidence shows that this assumption cannot be taken for granted. In some cases, the interventions that increase household economic activities actually lead to greater problems for children and youth, such as more child labor and less school attendance, particularly in the short term.