Author
Adriane Martin Hilber
Other affiliations: University of Basel, University of Bern
Bio: Adriane Martin Hilber is an academic researcher from Swiss Tropical and Public Health Institute. The author has contributed to research in topics: Reproductive health & Population. The author has an hindex of 14, co-authored 33 publications receiving 939 citations. Previous affiliations of Adriane Martin Hilber include University of Basel & University of Bern.
Topics: Reproductive health, Population, Human rights, Accountability, Vagina
Papers
More filters
University of Bern1, University of the Witwatersrand2, Ghent University3, University of London4, University of Amsterdam5, University of Washington6, University of California, Los Angeles7, University of Toronto8, Africa Center9, Research Triangle Park10, University of Cape Town11, Columbia University12, RTI International13
TL;DR: Pooling of data from 14,874 women in an individual participant data meta-analysis by Nicola Low and colleagues reveals that some intravaginal practices increase the risk of HIV acquisition.
Abstract: Background: Identifying modifiable factors that increase women’s vulnerability to HIV is a critical step in developing effective female-initiated prevention interventions. The primary objective of this study was to pool individual participant data from prospective longitudinal studies to investigate the association between intravaginal practices and acquisition of HIV infection among women in sub-Saharan Africa. Secondary objectives were to investigate associations between intravaginal practices and disrupted vaginal flora; and between disrupted vaginal flora and HIV acquisition. Methods and Findings: We conducted a meta-analysis of individual participant data from 13 prospective cohort studies involving 14,874 women, of whom 791 acquired HIV infection during 21,218 woman years of follow-up. Data were pooled using random-effects meta-analysis. The level of between-study heterogeneity was low in all analyses (I 2 values 0.0%– 16.1%). Intravaginal use of cloth or paper (pooled adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.18–1.83), insertion of products to dry or tighten the vagina (aHR 1.31, 95% CI 1.00–1.71), and intravaginal cleaning with soap (aHR 1.24, 95% CI 1.01–1.53) remained associated with HIV acquisition after controlling for age, marital status, and number of sex partners in the past 3 months. Intravaginal cleaning with soap was also associated with the development of intermediate vaginal flora and bacterial vaginosis in women with normal vaginal flora at baseline (pooled adjusted odds ratio [OR] 1.24, 95% CI 1.04–1.47). Use of cloth or paper was not associated with the development of disrupted vaginal flora. Intermediate vaginal flora and bacterial vaginosis were each associated with HIV acquisition in multivariable models when measured at baseline (aHR 1.54 and 1.69, p,0.001) or at the visit before the estimated date of HIV infection (aHR 1.41 and 1.53, p,0.001), respectively. Conclusions: This study provides evidence to suggest that some intravaginal practices increase the risk of HIV acquisition but a direct causal pathway linking intravaginal cleaning with soap, disruption of vaginal flora, and HIV acquisition has not yet been demonstrated. More consistency in the definition and measurement of specific intravaginal practices is warranted so that the effects of specific intravaginal practices and products can be further elucidated. Please see later in the article for the Editors’ Summary. Citation: Low N, Chersich MF, Schmidlin K, Egger M, Francis SC, et al. (2011) Intravaginal Practices, Bacterial Vaginosis, and HIV Infection in Women: Individual
247 citations
TL;DR: It is found that women in all four countries have a variety of reasons for carrying out vaginal practices whose aim is to not simply 'dry' the vagina but rather decrease moisture that may have other associated meanings, and that they are exclusively "intravaginal" in operation.
117 citations
TL;DR: Evidence on the role of supervision in Sub‐Saharan Africa has been inconclusive, despite the critical need to maximize the workforce in low‐resource settings.
116 citations
TL;DR: A pathway linking intravaginal cleaning practices with vaginal infections that increase susceptibility to HIV infection is plausible but conclusive evidence is lacking.
Abstract: BACKGROUND: Intravaginal practices are commonly used by women to manage their vaginal health and sexual life. These practices could, however, affect intravaginal mucosal integrity. The objectives of this study were to examine evidence for associations between: intravaginal practices and acquisition of HIV infection; intravaginal practices and vaginal infections; and vaginal infections and HIV acquisition. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a systematic review of prospective longitudinal studies, searching 15 electronic databases of journals and abstracts from two international conferences to 31(st) January 2008. Relevant articles were selected and data extracted in duplicate. Results were examined visually in forest plots and combined using random effects meta-analysis where appropriate. Of 2120 unique references we included 22 publications from 15 different studies in sub-Saharan Africa and the USA. Seven publications from five studies examined a range of intravaginal practices and HIV infection. No specific vaginal practices showed a protective effect against HIV or vaginal infections. Insertion of products for sex was associated with HIV in unadjusted analyses; only one study gave an adjusted estimate, which showed no association (hazard ratio 1.09, 95% confidence interval, CI 0.71, 1.67). HIV incidence was higher in women reporting intravaginal cleansing but confidence intervals were wide and heterogeneity high (adjusted hazard ratio 1.88, 95%CI 0.53, 6.69, I(2) 83.2%). HIV incidence was higher in women with bacterial vaginosis (adjusted effect 1.57, 95%CI 1.26, 1.94, I(2) 19.0%) and Trichomonas vaginalis (adjusted effect 1.64, 95%CI 1.28, 2.09, I(2) 0.0%). CONCLUSIONS/SIGNIFICANCE: A pathway linking intravaginal cleaning practices with vaginal infections that increase susceptibility to HIV infection is plausible but conclusive evidence is lacking. Intravaginal practices do not appear to protect women from vaginal infections or HIV and some might be harmful.
107 citations
Journal Article•
TL;DR: The most recent estimates indicating that about 536 000 women die every year from pregnancy-related causes demonstrate that, at the global level, maternal mortality has decreased at less than 1% annually between 1990 and 2005, which is far below the 55% annual decline necessary to achieve the Millennium Development Goal (MDG) of improving women's health by reducing maternal mortality as mentioned in this paper.
Abstract: Introduction Maternal and neonatal mortality have barely declined in the past two decades The most recent estimates indicating that about 536 000 women die every year from pregnancy-related causes demonstrate that, at the global level, maternal mortality has decreased at less than 1% annually between 1990 and 2005 (1) This is far below the 55% annual decline necessary to achieve the Millennium Development Goal (MDG) of improving women's health by reducing maternal mortality Ninety-nine percent of these deaths occur in developing countries Likewise, even as the under-five and infant mortality rates have dropped considerably in many developing countries, the rates for neonates (infants in the first 4 weeks of life) and, in particular, early neonatal mortality (infants in the first week of life) have declined much more slowly and in some regions have remained static (2) An estimated 4 million babies die during their first 4 weeks, of which 3 million die in the first week (3) Maternal and neonatal health are central for the MDGs, the global roadmap for eradicating poverty and improving human well-being by the year 2015 (4) While the right of parents to determine freely and responsibly the number and spacing of their children was first articulated in the 1968 UN International Conference on Human Rights, the right of women to go through pregnancy and childbirth safely was first made explicit only in 1994 as part of the Programme of Action of the UN International Conference on Population and Development (ICPD) The definition of reproductive health included "the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant" (5) Subsequently, three organizations--WHO, United Nations Children's Fund (UNICEF) and United Nations Population Fund (UNFPA) declared that: "The right to life is a fundamental human right, implying not only the right to protection against arbitrary execution by the state but also the obligations of governments to foster the conditions essential for life and survival Human rights are universal and must be applied without discrimination on any grounds whatsoever, including sex For women, human rights include access to services that will ensure safe pregnancy and childbirth" (6) These commitments were built upon a foundation laid by authoritative sources For example, the UN Human Rights Committee, which monitors implementation of the International Covenant on Civil and Political Rights, had previously confirmed that, in international law, the right to life not only applies to ensuring that capital punishment is not imposed in an arbitrary way but also requires that States adopt positive measures to ensure survival and development (7) In 2000, the Committee elaborated its General Comment 28 on the equality of rights between men and women which, among other things, requires States to report their progress and to provide data on birth rates and on pregnancy and childbirth-related deaths of women (8) Human rights are used by international organizations, governments, nongovernmental organizations, civil society groups and individuals in their work with respect to health in many different ways These can broadly be categorized as: advocacy, application of legal standards, and programming, including service delivery Some use one approach while others apply a combination in their work (9-12) To understand the historical context which shaped the rationale and approach of linking health and human rights to improving maternal and neonatal health, we summarize how maternal mortality in the developing world came to be seen as a public-health concern, a human rights concern, and ultimately as both, leading to the development of approaches using human rights concepts and methods Historical trends For most women living in industrialized countries, the experience of death and/or severe injury during childbirth is remote, both statistically and historically …
56 citations
Cited by
More filters
Harvard University1, New York University2, World Bank3, Mexican Social Security Institute4, Wellcome Trust5, Inter-American Development Bank6, University of Ibadan7, Northwestern University8, Bill & Melinda Gates Foundation9, Malawi University of Science and Technology10, University of London11, Duke University12, University of Bergen13, Public Health Foundation of India14, Centers for Disease Control and Prevention15, Stanford University16, Kathmandu17
TL;DR: High-quality health systems in the Sustainable Development Goals era: time for a revolution.
1,434 citations
TL;DR: This review undertook a systematic assessment of the relationship between HIV‐related stigma and ART adherence to systematically assess the relationship with ART adherence itself.
Abstract: Introduction: Adherence to HIV antiretroviral therapy (ART) is a critical determinant of HIV-1 RNA viral suppression and health outcomes. It is generally accepted that HIV-related stigma is correlated with factors that may undermine ART adherence, but its relationship with ART adherence itself is not well established. We therefore undertook this review to systematically assess the relationship between HIV-related stigma and ART adherence. Methods: We searched nine electronic databases for published and unpublished literature, with no language restrictions. First we screened the titles and abstracts for studies that potentially contained data on ARTadherence.Then we reviewed the full text of these studies to identify articles that reported data on the relationship between ARTadherence and either HIV-related stigma or serostatus disclosure. We used the method of meta-synthesis to summarize the findings from the qualitative studies. Results: Our search protocol yielded 14,854 initial records. After eliminating duplicates and screening the titles and abstracts, we retrieved the full text of 960 journal articles, dissertations and unpublished conference abstracts for review. We included 75 studies conducted among 26,715 HIV-positive persons living in 32 countries worldwide, with less representation of work from Eastern Europe and Central Asia. Among the 34 qualitative studies, our meta-synthesis identified five distinct third-order labels through an inductive process that we categorized as themes and organized in a conceptual model spanning intrapersonal, interpersonal and structural levels. HIV-related stigma undermined ART adherence by compromising general psychological processes, such as adaptive coping and social support.We also identified psychological processes specific to HIV-positive persons driven by predominant stigmatizing attitudes and which undermined adherence, such as internalized stigma and concealment. Adaptive coping and social support were critical determinants of participants' ability to overcome the structural and economic barriers associated with poverty in order to successfully adhere to ART. Among the 41 quantitative studies, 24 of 33 cross-sectional studies (71%) reported a positive finding between HIV stigma and ART non-adherence, while 6 of 7 longitudinal studies (86%) reported a null finding (Pearson's x 2 7.7; p0.005). Conclusions: We found that HIV-related stigma compromised participants' abilities to successfully adhere to ART. Interventions to reduce stigma should target multiple levels of influence (intrapersonal, interpersonal and structural) in order to have maximum effectiveness on improving ART adherence.
780 citations
TL;DR: The results suggest that highly prevalent genital bacteria increase HIV risk by inducing mucosal HIV target cells, and specific taxa highly prevalent in young healthy South African women that increase their HIV risk might be leveraged to reduce HIV acquisition in women.
447 citations
Dataset•
28 Oct 2015
TL;DR: The primary purpose of the report is to review the evidence in published and gray literature with regard to the definition, scope, contributors, and impact of disrespect and abuse in childbirth, to review promising intervention approaches, and to identify gaps in the evidence.
Abstract: Executive Summary This report is a review of the evidence on the topic of disrespect and abuse in facility-based childbirth. The primary purpose of the report is to review the evidence in published and gray literature with regard to the definition, scope, contributors, and impact of disrespect and abuse in childbirth, to review promising intervention approaches, and to identify gaps in the evidence. Despite the agreed importance among maternal health and human rights stakeholders of achieving respectful, non-abusive birth care for all women, there has been a relative lack of formal research around this topic. Lack of respectful and non-abusive care at birth may encompass many points along a continuum that spans dignified, patient centered care, non-dignified care, and overtly abusive maternal care. Examples of disrespect and abuse include subtle humiliation of women, discrimination against certain subgroups of women, overt humiliation, abandonment of care and physical and verbal abuse during childbirth. While it is likely that disrespect and abuse are often multi-factorial and may be perceived differently and sometimes normalized depending on the specific setting, many stakeholders and maternal health experts agree that disrespect and abuse in facility-based childbirth represent important causes of suffering for women, an important barrier to skilled care utilization (a key MGD-5 indicator), important quality of care problems, and often a violation of women's human rights. This document reviews reports of disrespect and abuse in facility-based childbirth across a range of birth care settings in low, middle and high income countries. The report intentionally focuses on care provided at the time of birth given the intense vulnerability of women during childbirth. Building on the results of an extensive review of the published and gray literature as well as results from a structured group discussion and individual interviews with expert informants, seven categories of disrespect are identified: physical abuse, non-consented clinical care, non-confidential care, non-dignified care (including verbal abuse), discrimination based on specific patient attributes, abandonment of care, and detention in facilities. Categories of disrespect and abuse draw on human rights and ethics principles and are intended to help synthesize a complex body of evidence. It is understood, however, that manifestations of disrespect and abuse often fall into more than one category. Categories are not intended to be mutually exclusive but rather to be overlapping along a continuum. After a review of categories of disrespect and abuse in childbirth, the report explores evidence for potential contributors to …
418 citations
TL;DR: At the epicentre of the HIV epidemic in southern Africa, adolescent girls and young women aged 15–24 contribute a disproportionate ~30% of all new infections and seroconvert 5–7 years earlier than their male peers.
Abstract: Introduction : At the epicentre of the HIV epidemic in southern Africa, adolescent girls and young women aged 15–24 contribute a disproportionate ~30% of all new infections and seroconvert 5–7 years earlier than their male peers. This age–sex disparity in HIV acquisition continues to sustain unprecedentedly high incidence rates, and preventing HIV infection in this age group is a pre-requisite for achieving an AIDS-free generation and attaining epidemic control. Discussion : Adolescent girls and young women in southern Africa are uniquely vulnerable to HIV and have up to eight times more infection than their male peers. While the cause of this vulnerability has not been fully elucidated, it is compounded by structural, social and biological factors. These factors include but are not limited to: engagement in age-disparate and/or transactional relationships, few years of schooling, experience of food insecurity, experience of gender-based violence, increased genital inflammation, and amplification of effects of transmission co-factors. Despite the large and immediate HIV prevention need of adolescent girls and young women, there is a dearth of evidence-based interventions to reduce their risk. The exclusion of adolescents in biomedical research is a huge barrier. School and community-based education programmes are commonplace in many settings, yet few have been evaluated and none have demonstrated efficacy in preventing HIV infection. Promising data are emerging on prophylactic use of anti-retrovirals and conditional cash transfers for HIV prevention in these populations. Conclusions : There is an urgent need to meet the HIV prevention needs of adolescent girls and young women, particularly those who are unable to negotiate monogamy, condom use and/or male circumcision. Concerted efforts to expand the prevention options available to these young women in terms of the development of novel HIV-specific biomedical, structural and behavioural interventions are urgently needed for epidemic control. In the interim, a pragmatic approach of integrating existing HIV prevention efforts into broader sexual reproductive health services is a public health imperative. Keywords: HIV prevention; adolescent girls; young women; prevention interventions. (Published: 26 February 2015) Citation: Dellar RC et al. Journal of the International AIDS Society 2015, 18(Suppl 1) :19408 http://www.jiasociety.org/index.php/jias/article/view/19408 | http://dx.doi.org/10.7448/IAS.18.2.19408
392 citations