A critical literature review of barriers to the prevention of mother-to-child transmission of HIV/AIDS in South Africa

HIV/AIDS is one of the most encompassing and highly recognized infectious pandemics in our world today. It contributes significantly to total overall deaths and to economic hardship in societies, particularly in underdeveloped and developing countries. Access to effective treatments for preventing mother-to-child HIV transmission (PMTCT) during pregnancy and birth remain challenging, especially in resources poor settings. South Africa has one of the highest prevalence rates of HIV/AIDS in the world, with 5.7 million people currently infected. The prevalence rate of South African women of childbearing age is almost 30%, and it is estimated that 40,000 children are born with HIV every year. PMTCT in South Africa could be nearly 100% because of ARV treatments like nevirapine; however, social, behavioral, and governmental factors inhibit access to preventative medication and adherence to medication schedules. This paper used a critical review of the literature on PMTCT in South Africa, specifically searching for barriers associated with specific interventions. The literature review found barriers to the PMTCT at various levels of the Social Ecologic Model: individual, interpersonal, community, institutional, and policy. The Individual level barriers included knowledge about HIV and PMTCT, knowledge of the HIV status of mother and infant, and knowledge, beliefs, and fear. The Interpersonal level barriers encompassed male involvement, the role of traditional health practitioners, and social support. The Organization level, few barriers were found in the literature review of the databases, but barriers were found through the review of history findings from the background sections. The Community level barriers were internalized AIDS stigma and infrastructure. At the Policy level, the only current barrier was CD4 count level for eligibility of government treatment. Adherence factors were multilevel barriers. The public health significance of MTCT is that 40,000 infants in South Africa are infected each year with HIV, a largely preventable disease, resulting in an unnecessary added burden to an already resource poor country