Role of social determinants of health in reducing mother-to-child transmission of HIV in resource-poor countries

Background: The HIV/AIDS pandemic has evolved along disparate epidemiological paths. This disparity is particularly evident in the prevention of mother-to-child transmission (PMTCT) of HIV. In resource-rich countries, the risk for HIV MTCT is less than 2%. In resource-poor countries, the risk may be as high 45%. A literature review was conducted to examine the current state of the PMTCT of HIV in resource-poor countries of sub-Sahara Africa. Methods: A literature review from 2000-2010 was conducted using the search terms: mother-to-child transmission, HIV/AIDS, Africa, social determinants. Using the Behavioral Model for Vulnerable Populations as a framework, this review identified barriers to access and use of healthcare, and health behaviors related to PMTCT of HIV. Results: The literature review identified HIV-related stigmatization and cultural norms as two important social determinants that play a role in PMTCT. These social determinants specifically influence attitudes and decisions related to HIV-testing, birthing practices, and infant feeding choices. Conclusions: Because of the contextual nature of social determinants, effective PMTCT programs should include components that address HIV-stigmatization and cultural norms. Results further suggest that PMTCT programs find creative ways to involve local stakeholders in program planning and support. Health interventions that promote a sense of community ownership are more likely to succeed than programs initiated solely by outside sources. This review concludes with the recommendation that a strategic paradigm built on enhanced community partnerships may serve as an important bridge linking clinical expertise to cultural acceptability in efforts to prevent MTCT of HIV in resource-poor countries.