Improving mothers' access to PMTCT programs in West Africa: a public health perspective

Despite technical means and apparent political will, the percentage of pregnant women involved in preventing mother-to-child transmission (PMTCT) interventions is not increasing as fast as public health authorities would expect. This is even more striking when compared to the scaling up of access to antiretroviral treatment. It seems important to analyze the successes and failures of the programs and the "scaling-up" of PMTCT programs. This is a major issue for women at two levels: women are very concerned about the health of their children, and they are the ones who implement prevention in collaboration with health services. A review of achievements and failures described from a public health perspective may lead to greater understanding of the social aspects involved in PMTCT program achievements and failures. This paper is based on the combination of a literature review and empirical evidence collected during 15 years of PMTCT implementation, childcare research and treatment programs in West Africa. The analysis aims to identify the social issues that explain the gap between PMTCT program aims and achievements in order to encourage research in the social sciences regarding relationships between mothers and the care system. We find it is possible to build programs at the national level that have a high degree of acceptance of testing and intervention, with a progressive decline in HIV infection among children. However, many obstacles remain, highlighting the necessity to broaden access to HIV screening, develop mass campaigns on testing for couples and improve HIV care and training for caregivers. Because HIV-infected pregnant women are experiencing great psychological distress, healthcare providers must use an approach that is as friendly as possible.