Blame & Banishment - Médecins du Monde

Blame and Banishment: The underground HIV epidemic affecting children in Eastern Europe and Central Asia
Drug users who happen to get pregnant or pregnant women with a drug-using problem?
In the dual epidemic of HIV and drug use affecting the region, drug-using pregnant women face multiple barriers linked to their drug use,
to HIV and to gender discrimination. Negative attitudes of health workers and people in the community often compel them to hide their
drug addiction from care providers in antenatal clinics. Because they tend to present for services late in pregnancy or only at delivery, the
opportunity to receive effective PMTCT is often missed. Even in cases where drug use is disclosed or identified during pregnancy, limited
referrals are available to services that provide the high-quality specialized care required to address pregnancy, drug use and HIV in an
integrated manner. Instead, vertical, compartmentalized care systems address each of these problems separately. For example, opioid
substitution can help stabilize drug use and improve pregnancy and neonatal outcomes, including the prevention of HIV infection. But
even in countries where treatment is legal and available, only very few pregnant women are able to benefit from it.
The challenge today is to change the attitudes of both society and health-care professionals so that these women are treated as ‘pregnant
women who have a problem of drug use’ and who need to be treated with dignity and respect, rather than just ‘drug users who happen to
be pregnant’, with all that this implies.
Under pressure: Finding whom to blame...
The reaction to weaknesses in the health system and in the provision of prevention and care
services is sometimes one of hiding data, laying blame and, in extreme cases, criminalizing
individual health workers, rather than addressing the
underlying systemic causes of the problems. Deliberate
concealment and manipulation of data in order to avoid the
appearance of problems have been reported at all levels
of the health system. According to information provided
by the World Health Organization (WHO), only two cases
of HIV were reported in Turkmenistan by 2008, whereas
unofficial reports indicate a substantial and unaddressed
epidemic in progress. 46 Initiatives to improve quality of
care, such as anonymous maternal mortality audits, have
been introduced only recently. In a number of countries,
moving away from a punitive approach, towards the use
of data as a tool to inform quality improvements in service
provision, remains a challenge.
An outreach worker talking to pregnant women
© Sophie Pinkham
In Central Asia, many children living with HIV have
become infected through unsafe blood transfusions
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