The aim of this commentary is to encourage professionals in North Africa and the Middle East to work collaboratively to create multidisciplinary networks and research forms to advance women’s health. The specific health problems to be addressed will be diverse and may include noncommunicable diseases such as cardiovascular disease, hypertension, type II diabetes, renal disease, cancer, and mental health. Other evolving and emerging social problems—such as substance use, intimate partner violence, displacement, and gender-based disparities—also deserve special attention. The work of the author and his colleagues in southern Africa is briefly presented as an example of collaborative research among women and their children, highlighting the innovative approaches that have been attempted to reduce the burden of human immunodeficiency virus (HIV) /acquired immunodeficiency syndrome. It is based on more than 30 years of work experience in building infrastructure through training, developing clinical and laboratory facilities, and engaging the community. Equally important is the ability to raise funds through writing grants and being able to deliver to keep sponsors and stakeholders interested and satisfied. Globally, women face profound health challenges, and in settings such as sub-Saharan Africa, living with HIV and the lifelong use of antiretroviral therapy presents a substantial burden. To date, 62% of new HIV infections in Africa are among women and girls. 1 Our research work in southern Africa has resulted in groundbreaking innovations that have significantly improved maternal health and HIV prevention strategies—many of which have been adopted worldwide. Through extensive collaborative research, we have developed and implemented pioneering interventions that have significantly reduced HIV transmission and enhanced overall women’s health in resource-constrained settings. These contributions have set precedents in global health policies, including recommendations by the World Health Organization (WHO) and other major health agencies. One of the most significant achievements has been the collaborative research conducted to reduce the vertical transmission of HIV from mothers living with HIV to their children, either during delivery or postnatally through breastfeeding. For example, the figure shows data from the Republic of Malawi. In the early 1990s, HIV transmission rates from women living with HIV to their newborns were as high as 35%. Through a series of groundbreaking clinical trials, we developed novel perinatal and postnatal non-antiretroviral and antiretroviral strategies that reduced the transmission rate to less than 0. 5% during the period from 1990 to 2026 (Figure 1). 2–12 This remarkable success has had a profound impact on reducing morbidity and mortality for both children and their mothers. Our findings served as the foundation for WHO’s global recommendations on preventing perinatal HIV transmission. Today, all women who test positive for HIV at any stage receive antiretroviral treatment as the standard of care throughout Africa. The rates of perinatal HIV transmission are extremely low (<2. 0%). Figure 1: Rates of Perinatal HIV Transmission in Blantyre, Malawi, 1990–2016Our research extended beyond HIV to address broader maternal health issues. One particularly impactful intervention was the introduction of a simple, low-cost method to reduce postpartum sepsis and early neonatal deaths: cleaning the birth canal with a chlorhexidine solution. 4 This approach is locally relevant, low cost (costs only 5 cents), and can be performed by midwives, making it highly scalable in resource-constrained settings. This simple technique, which significantly reduces maternal sepsis and early neonatal mortality, is now widely adopted as a standard of care both in Africa and beyond. Additionally, for mothers who were unable to reach healthcare facilities in time for delivery—often referred to as “late presenters”—we developed a method to reduce newborn HIV infection by administering post-exposure prophylaxis with antiretrovirals to the infant. This innovation, published in The Lancet and JAMA, 8, 9 has provided a critical solution for high-risk deliveries, further reducing perinatal HIV transmission in challenging settings. One of the most significant barriers to HIV prevention in sub-Saharan Africa is the lack of empowerment among women, who often have limited ability to negotiate safer sexual practices. Recognizing this barrier, we explored women-controlled prevention methods, such as vaginal microbicides products that can be used vaginally to prevent infections such as HIV and other sexually transmitted infections (STIs). The concept of vaginal microbicides is appealing because they are woman-controlled, especially in settings where communication between male and female partners on reproductive health is challenging. The research teams in eastern and southern Africa were among the first globally to conduct trials on these products for preventing the acquisition of HIV and STIs in women. A more recent product known as “dapivirine” vaginal ring (a product coated with an antiretroviral agent) is an innovative HIV prevention tool that women can apply themselves and use for approximately 1 month. 13 Our research teams have demonstrated that the ring effectively reduces the risk of HIV acquisition, providing women greater control over their health. This intervention is now approved by the WHO and African regulators, and is available over the counter at an affordable cost of approximately 7. In addition to microbicides, we showed in multicountry studies on discordant couples—where one partner is living with HIV (LWH) and the other is not—that treating the partner who is LWH with antiretroviral drugs reduces the risk of transmission by 96%. These results were transformative, forming the basis for the “test and treat” approach, which is now a cornerstone of HIV prevention strategies worldwide. 14 Collaborative work in southern Africa was strongly encouraged through joint meetings to discuss and develop priority protocols, shared funding, and creation of leadership groups/networks. For example, collaborative efforts included Uganda, Malawi, Zimbabwe, and South Africa. Based on longitudinal evaluations of the health of women of reproductive age in these countries, we have shown that long-term use of antiretrovirals is safe, strengthens the immune system, substantially reduces HIV transmission to newborns, and enhances overall general maternal health outcomes. 15. We showed that African women can consistently adhere to long-term use of antiretroviral regimens. Women were also extremely satisfied with their quality of life; with 87. 5% reporting their health as either excellent or very good. 15 A key aspect of the research work in southern Africa has been the development of local infrastructure and the training of scientists in these countries. Through grants from the National Institutes of Health and the Fogarty International Center, multi-year training programs were conducted for local scientists in women’s health, HIV research, biostatistics, bioinformatics, and laboratory sciences. Both formal and informal practical training sessions were provided. In addition to training, support was provided for the development of physical infrastructure for health research, including key areas such as laboratory and pharmacy capabilities. These facilities serve as vital centers for ongoing research and training, and play a key role in ensuring long-term sustainability. The status of women in many countries, especially in Africa, remains precarious, with health priorities for women in these regions are not yet well defined. While women are living longer, they continue to face challenges. Some of these relate to a lack of empowerment and inherent biases, some relate to changing disease risk factors (especially obesity and lack of physical activity), and others relate to demographic transitions. These barriers need to be recognized through evidence-based research, with active involvement of stakeholders and policymakers at the highest level. Our experience in southern Africa shows that collaborative work and multicountry networks can be successful and rewarding. Working closely with local communities, stakeholders, and institutions can ensure that women’s health remains a priority to make a lasting impact for years to come.
Taha E. Taha (Wed,) studied this question.
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