Can mother-to-child transmission of HIV be eliminated without addressing the issue of stigma? Modeling the case for a setting in South Africa

Holly J. Prudden, Matthew Hamilton, Anna M. Foss, Nicole Dzialowy Adams, Melissa Stockton, Vivian Black, Laura Nyblade PLOS One, 2017; Read the full article online

Stigma and discrimination continue to undermine the effectiveness of the HIV response. Despite a growing body of evidence on the negative relationship between stigma and HIV outcomes, there are insufficient data available on the prevalence of stigma and its impact. This paper presents a probabilisic cascade model to estimate the magnitude of the impact that stigma has on mother-to-child transmission.

The model projections demonstrate how the negative effect of stigma on retention of women across the prevention of mother-to-child transmission (PMTCT) cascade can be relatively small at any given stage of the cascade but combines throughout the stages overall. Cumulatively, the effect of stigma in increasing the number of new infant HIV infections can be substantial. The cumulative nature of the PMTCT cascade can be harnessed for efficiency in investment by prioritising interventions that can affect multiple stages of the cascade simultaneously, the most obvious of which are interventions to reduce stigma directly.

In the absence of empirical data on stigma, modeling offers an important, if imprecise, starting point to begin grappling more directly with this continuing and potentially large gap in the HIV response."

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